Case manager has patience for patients

2016-05-11 06:00
   PHOTO: nicole              john Case manager Merle Williams of Midlands Medical Centre.

PHOTO: nicole john Case manager Merle Williams of Midlands Medical Centre.

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AN area of nursing that often goes unnoticed is the work of a case manager.

The primary job of a case manager is to ensure that during a patient’s stay in hospital “we act as the patient’s advocate and ensure they get the best possible care, at the most affordable price without compromising on the quality of care that they receive”, said Midlands Medical Centre case manager, Merle Williams.

Williams, who won the South African Case Manager of the Year at in the Private Hospital Category from the Case Management Association of South Africa in 2013, sat down with Maritzburg Fever to discuss the important role a case manager plays within a hospital environment, in celebration of Nurses Day, which is celebrated tomorrow 12 May, Florence Nightingale’s birthday.

The day celebrates nurses who work long hours, late nights and dedicate their lives to helping others. Case managers are also acknowledged as people who advocate for the patient’s needs and play a mediating role between the atient and medical aid, and between patient and doctor.

Williams, who has 30 years’ experience in the nursing profession, has been a case manager for the past 18 years. Over the years she has fought many battles on patients’ behalf, ensuring that their bills get paid by their medical aid, and that they receive the best care.

She explained that every day she and her colleagues visit patients in their wards checking on their progress and ensuring that the medical aid is updated with all the relevant information to ensure that their stay in hospital is covered in full.

“When I visit them I introduce myself and tell them they need to make sure they get better and that I am here to ensure their bills get paid by their medical aid. I’ve often gone beyond the call of duty for my patients. It’s all about educating them on the rules and limitations on their medical aid to ensure their expenses are paid in full.

“In the current economic climate, it’s not fair for a patient to have to pay medical bills, while contributing to a medical aid.”

Williams said she has a passion for helping people and, even though she is not on the floor as a nurse, she gets to interact with people and help them in other ways, which is fulfilling for her.

“I’ve learnt a lot over the years. I’ve improved my skills and knowledge through coding courses, and it’s been very rewarding. I believe that we, as case managers, play a vital role in the hospital as we have to ensure maximisation of hospital revenue through correct ICD and CPT coding, accurate hospital and/or medical aid contract interpretation, precise case management processes and timeous submission of accounts to medical aid.

“I’ve never regretted making the move from nursing because I still get to help people­, which is what I love,” said Williams.


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