Case Manager

Sibanye-Stillwater; Rustenburg; On-site; ZAR 200 000 - 300 000; Full time

Job summary

A mining company in South Africa is seeking a qualified Professional Nurse to manage case management and report occupational health incidents. The ideal candidate should have at least 5 years of experience in a managed health care environment, alongside key qualifications in nursing and case management. Responsibilities include validating and reporting incidents, managing injury cases, and coordinating with medical scheme case managers. This role requires strong attention to detail and the ability to work under pressure.

Qualifications

• Professional registration with CMASA and South African Nursing Council required.
• At least 5 years clinical or managed health care experience.
• Strong case management industry knowledge necessary.

Responsibilities

• Validation and reporting of occupational diseases and injuries.
• Management of injury on duty cases and health incidents.
• Coordinate with medical scheme CMs for clinical case management.

Skills

Extensive experience in case management

Proven computer proficiency in MS Office

Ability to work under pressure

Education

NQF 7/8 Professional Nurse

ICD 10 coding certificate

Business management certificate/diploma

Job description

Minimum Qualifications

• Professional registration with Case Management Association of South Africa (CMASA)
• Professional registration with the South African Nursing Council
• At least 5 years clinical work experience or medical schemes experience in a managed health care environment either at a medical scheme facility or a health facility
• NQF 7/8 Professional Nurse with basic qualifications in Midwifery/Psychiatry/Community Health Nursing/Occupational Health Care/Degree in Nursing (BA Cur / BTech)
• ICD 10 coding certificate

Requirements

• Extensive experience in case management (CRM, DM & ORM)
• Proven computer proficiency in MS Office
• Strong case management industry knowledge with the ability to extract, organize and capture significant amounts of electronic information with attention to detail and accuracy
• Ability to work under pressure and in a stressful environment
• Prepared to work extended hours on an ad‑hoc basis
• Clear security screening record
• Clear credit record
• Valid driver’s licence (if applicable)

Advantageous Qualifications

• Business management certificate/diploma

Key Responsibilities

• Validation and reporting of occupational diseases and injuries
• Capture occupational sick leave – mine accident and occupational diseases
• Check and verify accuracy of RMA reports captured
• Provide critical management of injury on duty and health incidents (heat disorders) as per mine accident policy and submission of claims and required documentation to both insurers (RMA + WCA)
• Management of injury on duty cases to include appropriate referral to preferred provider hospitals and specialists, hospital updates, outpatient scheduling, rehabilitation, work hardening, FWC-PWC/COF assessment, back‑to‑work program and disability management
• Ensure that applicable ICD 10 codes and procedure codes are applied accurately as per ICD 10 coding rules and regulations on the company databases
• Coordinate and collaborate with medical scheme CMs to identify terminally ill patients with poor prognosis that have reached MMI (maximum medical intervention) for possible medical incapacitation and ill‑health repatriation process
• Assist in collation of clinical reports from service provider to the OMP and possible referral back any applicable case to PHC/Treating Dr as per medical schemes protocols and guidelines
• Coordinate and collaborate with schemes CMs with clinical case management processes (in‑hospital clinical risk management + pre‑authorization) and utilisation review (Mine Direct: Step Down: TB cases, ad‑hoc – health management clinical funding approvals)
• Form part of the multidisciplinary team in actively managing mine accident cases in collaboration with the responsible occupational medical practitioner
• Linkage of employees identified with health risks to definitive care programmes
• Management of mine accident fatal cases post‑mortems and forensic management
• Management of employees with depleted benefits and referral into state services
• Case management of occupational diseases (i.e., silicosis, NIHL/COAD, CRTB/platinosis and occupational dermatitis)
• Ensure linkage to care of employees identified with risks during the surveillance programme as well as long‑term follow‑up and compliance including telemedicine consultations
• Participate in occupational health clinical review committee
• Create pre‑authorization of special cases: Mine Direct accounts according to approvals framework process (occupational health requirements: safety goggles, audiograms, special occupational health pathology test, special clinical management request, etc.)
• Ensure the management and timely review of vulnerable employees (fit with restriction, Long Covid, substance use disorders) as per restrictions imposed by the OMP (e.g., cardiac/respiratory/immunological diseases, maternity, drug abuse, insulin dependence, diabetic, epilepsy, mental health disorder and employees on anticoagulation therapy including stage 4 and 5 renal failure on dialysis)
• Medical incapacity management – clinical and administrative management of employees medically incapacitated
• Management of temp unfit and permanently unfit employees in the management of medical absenteeism in collaboration with the OH team
• Management of post‑employment benefits: TEBA program – TB management and home base care (HBC)
• Management of benefit medical examination and employees who qualify for benefits under ODIMWA