Case Manager

The Good Human (Pty)Ltd; Johannesburg; On-site; ZAR 500,000 - 700,000; Full time

Job summary

A leading healthcare provider is seeking a Hospital Case Manager to oversee case management processes at hospital level. The successful candidate will utilize clinical knowledge to minimize financial risk and ensure accurate billing through comprehensive coding. This is a short-term contract position offering an opportunity to showcase skills in a dynamic environment.

Qualifications

• 5 years’ experience as a hospital case manager.
• Knowledge of private healthcare operations.

Responsibilities

• Ensure compliance with case management procedures, standards, and protocols.
• Plan, coordinate, and execute clinical coding.

Skills

Attention to detail

Clinical knowledge

Education

Diploma in Nursing

Tools

ICD-10 Coding

CPT Coding

Job description

Clinix Dr SK Matseke Memorial and Tshepo – Themba hospitals

To plan, coordinate, and execute case management work at the hospital level. The incumbent utilizes clinical knowledge to minimize financial risk and ensure accurate billing through comprehensive and precise coding of patient care.

This is a short-term contract position, starting in May 2025.

Minimum Requirements :

• Diploma in Nursing
• 5 years’ experience as a hospital case manager
• Knowledge of ICD-10 and CPT Coding
• Knowledge of private healthcare operations
• Attention to detail and ability to verify the accuracy of files

Minimum work experience :

• Ensure compliance with case management procedures, standards, and protocols.
• Plan, coordinate, and execute clinical coding in accordance with relevant CHG standards and protocols.

Additional responsibilities include:

• Timely and consistent communication and follow-up with funders (Medical Aids, COID).
• Providing appropriate clinical information to funders to update Length of Stay, Level of Care, formulary utilization, assistive devices/prostheses, diagnostic interventions, therapy interventions, procedural interventions, and any required changes in patient treatment.

Additional responsibilities include:

• Investigate and understand the needs of funders, doctors, nurses, and patients to enable the delivery of quality service.
• Ensure timely resolution of stakeholder queries and complaints, taking ownership of case management and reimbursement issues.

Other key responsibilities:

• Escalate potential risks that could lead to increased costs or financial losses.
• Maintain accurate records of patient care and submit them promptly to funders to ensure appropriate reimbursement.

Additional duties include:

• Liaise with the billing department regarding the conversion of medical aid patients to cash.
• Adhere to statutory standards, policies, and procedures within the business unit to ensure compliance and take remedial action where necessary.