Langelihle Mazibuko
Care Coordinator
Gauteng
Summary
I am a case manager with 10 year of experience in a private health care setting. Spearheaded case management team collaborating with credit controllers for impressive funder collection, aiming at collecting above calculated targets.
Actively managed DNYB and PIP for effective collection.
Also have vast experience with managing people and processes involved in patient administrative services.
Have worked with deferent medical aids and has a clear understanding of SLA ,SOP and TAT .
I have an advance clinical coding certicate and also has certification in CPT /CCSA and knowledge ofNRPL codes
Overview
21
21
years of professional experience
Work History
Care Coordinator
Afrocentric/GEMS
Florida
04.2024 - Current
- Advocated for patients'' rights within the healthcare system, working diligently to address concerns or barriers to care.
- Coordinated discharge planning, ensuring a smooth transition from hospital to home or other facilities.
- Streamlined information sharing between healthcare providers by implementing secure electronic communication systems.
- Contributed to the development of organizational policies and procedures related to care coordination, ensuring alignment with industry standards and best practices.
- Utilized data analysis tools to identify trends in patient needs, allowing for more targeted intervention strategies.
- Assessing treatment plan provided by the service provider
- Ensuring that members have sufficient benefit to cover proposed treatment
- Liase with medical advisor where benefits have been exhausted
- Liase with medical advisor funding decision in complex cases
Senior Case Manager
Waterfall Hospital Netcare
Midrand
12.2022 - 03.2024
- Created well-written, effective care plans appropriately matching needs of clients following standards and guidelines of funders, contractors and governmental regulations.
- Provided service and supportive counseling in client's native language, translating and interpreting between client, family and third-party entities.
- Maintained accurate documentation of client interactions, facilitating seamless information sharing within the team.
- Increased client satisfaction by providing exceptional service, empathy, and timely assistance in resolving issues.
- Informally mentored new case managers and service coordinators, answering questions, offering opportunities to shadow and observe and explaining basic information about company procedures.
- Provided safety planning, crisis intervention and case management to clients.
- Implemented data-driven decision-making processes to optimize services provided to clients.
- Reduced client wait times with effective prioritization and time management strategies.
- Spearheaded initiatives aimed at streamlining workflows within the department, reducing administrative burdens on staff members while maintaining high-quality services for clients.
- Served as case coordinator, assuming responsibility for complex, high-volume assignments and guiding endeavors to successful completion.
- Communicated with supervisor regarding issues related to case management, resourcing, service collaboration and development of new resources.
- Identified care needs of individual patients and coordinated responses based on physician advice, insurance limitations, and procedural costs.
- Partnered with physicians, social workers, activity therapists, nutritionists, and case managers to develop and implement individualized care plans and documented patient interactions and interventions in electronic charting systems.
- Assessed community needs and identified resources for social and community service programs.
Case Management Specialist
Newcastle Mediclinic
01.2017 - 11.2022
- Created well-written, effective care plans appropriately matching needs of clients following standards and guidelines of funders, contractors and governmental regulations.
- Evaluated program effectiveness regularly to identify areas for improvement and implement evidence-based changes accordingly.
- Mentored advocates, case managers, interns and volunteers to create positive, productive atmosphere.
- Streamlined processes within the department, resulting in increased efficiency and better resource allocation.
- Kept up-to-date with industry trends and changes in regulations, adjusting case management strategies as needed to maintain optimal service delivery.
- Supported colleagues through mentoring and sharing best practices, promoting a culture of continuous learning within the team.
- Assisted with hiring and training of new advocates, interns, and volunteers, providing feedback on applicant work aptitude and team compatibility.
- Facilitated timely transitions between care settings by coordinating with healthcare providers, families, and insurance companies.
- Enhanced client satisfaction through consistent communication and regular updates on case progress.
- Provided safety planning, crisis intervention and case management to clients.
- Communicated with supervisor regarding issues related to case management, resourcing, service collaboration and development of new resources.
- Conducted thorough assessments of clients'' needs to determine appropriate services and support.
- Monitored the effectiveness of case management plans and adjusted strategies as needed to maximize results.
- Maintained accurate records and documentation, ensuring compliance with regulatory requirements and facilitating seamless audits.
- Oversaw implementation of case management program, collaborating with management to achieve smooth operations.
- Informally mentored new case managers and service coordinators, answering questions, offering opportunities to shadow and observe and explaining basic information about company procedures.
- Teamed up with managers and executives to assist in evaluating and improving performance of direct services, contributing to strategic program planning and development.
- Reduced hospital readmissions by proactively identifying potential barriers to successful discharge planning.
- Managed a caseload of diverse clients, successfully addressing their unique needs while maintaining high standards of service delivery.
- Advocated for clients'' best interests during meetings with healthcare providers, ensuring they received necessary care and interventions.
- Provided service and supportive counseling in client's native language, translating and interpreting between client, family and third-party entities.
- Assisted in the development of department policies and procedures that aligned with industry standards and best practices.
- Served as case coordinator, assuming responsibility for complex, high-volume assignments and guiding endeavors to successful completion.
- Improved patient outcomes by developing and implementing tailored case management plans.
- Made appropriate referrals, monitored client services in appropriate time frames, sought supervisory guidance as required, documented services provided and completed departmental billing procedures.
- Facilitated communication between all parties involved in a case, ensuring a clear understanding of responsibilities and expectations.
- Provided leadership, guidance and support to staff members.
- Monitored program performance and outcomes for successful delivery of services.
- Developed and implemented training programs for staff.
- Established and maintained relationships with key stakeholders.
- Analyzed trends and data to inform decision-making and program development.
- Collaboration with credit controllers where short payment has been detected
- Ensuring that DNYB is properly manage to improve collection
- Motivating for short payments
- Identifying shortfalls in case management
Neonatal Critical Care
Newcastle Mediclinic
01.2013 - 01.2017
- Conducted patient assessments, recorded vitals, and analyzed records and charts to define care requirements.
- Conducted equipment and vehicle checks to maintain continuous and safe operation.
- Evaluated patient vital signs and status to determine care needs using pulse oximeters and electronic vital sign machines.
- Delivered outstanding patient care in NICU critical care units.
- Assessed and managed various patient treatments for numerous patient diagnoses from sepsis to acute respiratory distress.
- Provided targeted care and treatment to premature babies /neonates
- Promoted a safe environment by strictly adhering to infection control guidelines and promptly addressing potential hazards in the critical care unit.
- Expedited patient recovery through diligent wound care management, IV therapy administration, and pain management strategies.
- Reduced hospital readmissions by effectively educating patients and families on post-discharge care and self-management techniques.
- Facilitated seamless transitions of care by conducting thorough handovers during shift changes and communicating pertinent information to incoming staff.
- Implemented evidence-based care protocols within the critical care unit, resulting in improved patient outcomes and adherence to industry standards.
- Mentored new hires through hands-on training sessions, fostering a supportive learning environment for team growth and development.
- Collaborated with hospital and facility staff to provide correct patient treatments.
- Improved patient outcomes by providing comprehensive support to physicians during critical procedures and interventions.
- Supported physicians during invasive procedures like central line placements or endotracheal intubations leading to safer executions.
- Consistently provided high-quality care under pressure, successfully managing multiple priorities during critical situations and emergency scenarios.
- Proactively identified potential complications by closely observing patients for signs of clinical deterioration, alerting medical staff as needed.
- Participated in continuous professional development opportunities to stay current on industry best practices for critical care delivery.
- Streamlined workflow processes by maintaining accurate medical records, ensuring timely communication between doctors, nurses, and other staff members.
- Completed files for treatment options and billing information.
- Assisted physicians in updating treatment plans by providing accurate and timely information on patients'' progress and response to interventions.
- Assisted in life-saving procedures such as CPR, defibrillation, and emergency airway management, ultimately improving patient survival rates.
- Collaborated with multidisciplinary healthcare teams, contributing valuable insights for individualized patient treatment plans.
- Enhanced patient care by meticulously monitoring and recording vital signs, administering medications, and assisting with daily living activities.
- Optimized resource utilization by efficiently managing supplies inventory and proactively identifying equipment maintenance needs.
- Coordinated with healthcare staff from various disciplines to devise, carry out, and manage personalized care plans to benefit patient health and recovery.
- Trained and coached new employees on protocols and best practices to promote ideal patient outcomes.
- Oversaw various aspects of telemetry by administering pa catheters and arterials, vasoactive drugs, titration, thrombolytic therapy, dysrhythmia interpretation, and chest tubes.
- Collaborated with medical and administrative personnel to maintain patient-focused, engaging and compassionate environment.
Neonatal Critical Care
Baragwanath Hosp
01.2012 - 01.2013
Case Management
Medical Services Organization
01.2010 - 01.2012
- Streamlined case management processes for improved efficiency in patient assessments and referrals.
- Assisted in case management duties, streamlining processes for efficient service delivery.
- Enhanced client satisfaction by conducting comprehensive assessments and developing personalized case management plans.
- Improved client outcomes by implementing comprehensive case management strategies and action plans.
- Developed and implemented effective strategies for improved case management, ensuring timely resolutions.
- Streamlined case management processes for increased efficiency and organization.
- Monitored case management system and handled customer phone calls.
- Streamlined internal processes by implementing efficient case management systems that improved staff productivity.
- Enhanced case management through regular monitoring, reviewing, and updating of individualized service plans.
- Improved firm efficiency by streamlining case management processes and procedures.
- Ensured timely and accurate data entry, resulting in improved case management.
- Maintained accurate documentation of all case management activities, ensuring compliance with regulatory standards.
- Improved claim resolution efficiency by implementing streamlined processes and coordinating case management.
- Increased client satisfaction with timely interventions and effective case management strategies.
- Developed strong relationships with clients, maintaining open communication lines for better case management.
- Enhanced teamwork abilities through participation in interdisciplinary meetings discussing complex case management scenarios.
- Provided comprehensive case management services, addressing various psychosocial factors impacting patient health outcomes.
- Improved patient outcomes by developing comprehensive case management plans tailored to individual needs.
- Enhanced department efficiency with thorough case management, organization, and prioritization.
- Provided ongoing case management services, monitoring progress and adjusting support strategies as needed.
- Reduced healthcare costs by streamlining case management protocols and maximizing resource utilization.
- Reduced claim processing time by streamlining workflow and implementing efficient case management strategies.
- Improved client outcomes by developing and implementing individualized therapeutic case management plans.
- Conducted ongoing evaluations of case management services to inform continuous quality improvement initiatives.
- Mitigated financial risks associated with litigation by establishing effective case management strategies.
- Enhanced organizational efficiency by streamlining case management processes and reducing paperwork redundancies.
- Enhanced client satisfaction by providing tailored case management support and resources.
- Performed detailed follow-up patient assessments per case management plans and hospital policies.
- Reduced case backlog significantly by implementing new case management strategies.
- Provided comprehensive case management services to ensure coordinated, effective interventions.
- Assisted in development of case management system, leading to more timely case resolutions.
- Optimized case management systems to facilitate streamlined reporting and analysis of escalation data.
Unit Nursing Manager
Claytonhouse Rehab Center
01.2009 - 01.2010
- Recruited hired, and onboarded top nursing talent to strengthen our team''s capabilities further.
- Championed quality improvement projects that led to enhanced clinical outcomes and increased efficiency in nursing processes.
- Spearheaded initiatives to improve employee retention rates and decrease turnover through mentorship programs, competitive compensation packages, and recognition of outstanding performance.
- Promoted a positive work environment by addressing staff concerns promptly and providing resources for professional development opportunities.
- Led infection control efforts within the unit, resulting in lowered infection rates among patients under our care.
- Delegated responsibilities effectively amongst team members according to individual strengths and areas of expertise which allowed for smooth transitions during shift changes and increased overall productivity.
- Facilitated open lines of communication between staff, families, and patients by holding regular meetings and ensuring clear documentation in patient records.
- Enhanced staff performance through regular evaluations, feedback, and tailored coaching sessions.
- Assessed staffing needs accurately during crucial times such as holidays or flu season to ensure adequate coverage without overstaffing or creating unnecessary financial burden.
- Implemented timely discharge planning strategies that reduced length of stay without compromising patient care quality or safety.
- Managed departmental budget effectively, identifying cost-saving opportunities while maintaining high-quality care delivery.
- Served as a key liaison between nursing staff, physicians, and administration, fostering collaboration across all stakeholders.
- Collaborated with interdisciplinary teams to optimize patient outcomes and streamline communication between departments.
- Fostered a culture of continuous improvement by leading team training sessions on new technologies and best practices in nursing management.
- Achieved high patient satisfaction scores through exceptional leadership in patient-centered care initiatives.
- Improved patient care by implementing evidence-based nursing practices and protocols.
- Maintained regulatory compliance by staying up-to-date with changing industry standards and ensuring staff adherence to policies and procedures.
- Developed and implemented effective nurse scheduling to optimize staffing levels and minimize overtime costs.
- Supervised, directed, and motivated high-quality performance from nursing staff.
- Trained new nurses in proper techniques, care standards, operational procedures, and safety protocols.
- Coordinated and implemented in-service educational programs focusing on safety and adherence to protocols.
- Developed and implemented quality improvement initiatives to provide best possible patient care and identify and address areas of concern.
- Led staff meetings to keep team informed of departmental changes and provide opportunities for nurses to share ideas and concerns.
- Reviewed department performance and adjusted coverage to compensate for changing conditions.
- Investigated and independently resolved complaints from staff, physicians, and patients by leveraging clinical judgment and unit management expertise.
- Conducted routine facility inspections, identifying areas needing improvement and eliminating hazards posed to staff and residents for continued compliance with associated regulations.
- Recruited, hired and trained all staff, providing direct supervision, ongoing staff development and continuing education to employees.
- Designed and introduced leadership development, coaching and team management model, resulting in promotion of employees into increased levels of responsibility.
Professional Nurse
Linksfield Park clinic
01.2004 - 01.2009
- Promoted a safe and hygienic environment through diligent infection control practices.
- Conducted comprehensive health assessments to identify potential issues requiring intervention or further evaluation.
- Improved patient outcomes by developing and implementing individualized care plans.
- Maintained strict adherence to regulatory guidelines while performing nursing duties, ensuring compliance with all applicable standards.
- Educated patients on preventative measures for chronic illnesses, promoting positive lifestyle changes that contribute towards overall health.
- Collaborated with interdisciplinary team members to provide comprehensive patient care.
- Enhanced patient satisfaction through compassionate and empathetic communication.
- Implemented effective pain management strategies, optimizing patient comfort levels during their stay.
- Provided emotional support to patients and families during difficult medical situations, fostering trust and rapport with clientele.
- Utilized evidence-based practices to guide decision-making in patient care delivery.
- Managed time effectively, prioritizing tasks based on the urgency of patient needs.
- Continually assessed patient needs, updating care plans accordingly to optimize treatment effectiveness.
- Streamlined nursing procedures for increased efficiency and reduced errors.
- Reduced readmission rates by providing thorough discharge education and follow-up support.
- Participated in quality improvement initiatives, contributing ideas for process enhancements in nursing practice.
- Demonstrated strong clinical judgment when handling complex cases or responding to emergency situations.
- Served as a preceptor for new nurses, offering guidance and mentorship in clinical practice.
- Worked closely with physicians to develop accurate diagnoses and coordinate appropriate treatments plans.
- Trained new nurses in proper techniques, care standards, operational procedures, and safety protocols.
- Provided exceptional care to high-acute patients needing complex care such as ventilator management, extensive wound care and rehabilitation.
- Educated patients, families and caregivers on diagnosis and prognosis, treatment options, disease process, and management and lifestyle options.
- Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.
- Evaluated healthcare needs, goals for treatment, and available resources of each patient and connected to optimal providers and care.
- Organized and managed care of patients undergoing various therapies and procedures.
- Audited charts and reviewed clinical documents to verify accuracy.
- Maintained quality care and comfort for patients with heart failure, pulmonary hypertension, and other conditions.
- Advocated for patients by communicating care preferences to practitioners, verifying interventions met treatment goals and identifying insurance coverage limitations.
- Managed quality care for patients with heart failure, end-stage renal disease and coronary artery disease.
- Orchestrated quality-driven, cost-effective care in high-volume trauma setting.
- Documented treatments delivered, medications and IVs administered, discharge instructions, and follow-up care.
- Communicated with healthcare team members to plan, implement and enhance treatment strategies.
- Conducted ongoing monitoring and evaluations of behaviors and conditions, and updated clinical supervisors with current information.
- Delivered high level of quality care to diverse populations while overseeing patient admission and triaging based on acuity and appropriate department admission.
- Sustained quality standards by performing routine medication audits and upholding internal and industry best practices.
- Reported findings to quality departments after conducting routine restraint audits and worked with team to devise corrective actions for deficiencies.
- Led teams in driving successful patient outcomes by prioritizing standard of care and best practices.
- Collaborated with leadership to devise initiatives for improving nursing satisfaction, retention and morale.
Education
Advanced ICD-10 Coding - Clinical Coding
Mediclinic Southern Africs
Cape Town 09.2019
Certificate In Business Administration - Project Management
Wits Business School
Gauteng 06.2009
Diploma In Nursing - Nursing Science
Netcare Nursing Academy
Gauteng 03.2007
Skills
Written and verbal communication
Maritalstatus
Single
Homelanguage
isiZulu
Otherlanguage
English (speak, read and write)
Driverlicense
Code 10
Criminalrecord
None
Academicmerits
- Matric, Siyamukela High School, 1994
- BA Psychology, University of the North, 2000
- Enrolled Nursing Cert, Mc Cord Nursing Sc, 2003
- HIV/AID Peer Counselling, Mc Cord Nursing Sc, 2003
- Nursing Diploma, Netcare Nursing Academy, 2007
- Business Administration, Wits Business School, 2009
Keyresponsibilityareas
- Financial Risk Management
- Compliance to case management procedures, contracts and legal aspects
- Correct and timeous finalization of cases to facilitate reimbursement
- Consistently and timeous communication with the stakeholders through relevant case management channels
- Ensuring clinical coding standards and adherence as per LEVEL 3 coding guidelines
- Lead and Manage the people in Case Management Team
- ICD-10 CODING and CCSA/CPT coding knowledge
Competencies
Accuracy and attention to detail, Resilience, Mutual Trust and Respect, Team Approach, Reasoning Ability, Judgement, Performance Driven, Client Focus, Planning, Organizing and Implementing, Leading Others
Casemanagementreference
Hantie Olivier, Patient Administration Manager, 034 317 0626
Identitynumber
7801060412081
Personal Information
- Date of Birth: 01/06/78
- Gender: Female
- Nationality: South Africa
Timeline
Care Coordinator
Afrocentric/GEMS
04.2024 - Current
Senior Case Manager
Waterfall Hospital Netcare
12.2022 - 03.2024
Case Management Specialist
Newcastle Mediclinic
01.2017 - 11.2022
Neonatal Critical Care
Newcastle Mediclinic
01.2013 - 01.2017
Neonatal Critical Care
Baragwanath Hosp
01.2012 - 01.2013
Case Management
Medical Services Organization
01.2010 - 01.2012
Unit Nursing Manager
Claytonhouse Rehab Center
01.2009 - 01.2010
Professional Nurse
Linksfield Park clinic
01.2004 - 01.2009
Advanced ICD-10 Coding - Clinical Coding
Mediclinic Southern Africs
Certificate In Business Administration - Project Management
Wits Business School
Diploma In Nursing - Nursing Science
Netcare Nursing Academy
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