Clinical Case Manager

Mediplus SA; Mbombela; On-site; ZAR 300,000 - 500,000; Full time

Job summary

A healthcare organization is looking for a dynamic Clinical Case Manager in Nelspruit, South Africa. The role involves managing high-risk cases, coordinating care, and evaluating complex conditions to ensure quality healthcare. Ideal candidates will have a Bachelor's degree in Nursing or Healthcare Management and at least 2 years of case management experience. Strong analytical and communication skills are also essential. This position requires occasional travel between South Africa and Mozambique.

Qualifications

• Active registration with the South African Nursing Council (if applicable).
• Minimum of 2 years’ case management experience within managed healthcare.
• Proven experience in managing chronic conditions and hospital case reviews.

Responsibilities

• Manage high-risk in-hospital cases and facilitate pre-authorisations.
• Evaluate chronic and complex conditions, conduct audits, and analyse billing data.
• Liaise with hospitals and service providers to align care and benefit utilisation.

Skills

Case management

Analytical skills

Communication skills

Negotiation skills

Education

Bachelor’s degree in Nursing or Healthcare Management

Tools

MS Office

Job description

Location: Nelspruit, South Africa

Department: Clinical Benefits

Organisation: Mediplus SA

Application Deadline: 4 August 2025

Are you a healthcare professional passionate about case management and clinical excellence? Mediplus SA is looking for a dynamic and detail-oriented Clinical Case Manager to join our Clinical Benefits team. This is an exciting opportunity to contribute to a high-performing team dedicated to improving healthcare outcomes and managing clinical benefits for our members.

Key Responsibilities:

• Manage high-risk in-hospital cases and facilitate pre-authorisations and discharge planning.
• Apply clinical protocols to ensure quality care and cost-effective treatment.
• Evaluate chronic and complex conditions, conduct internal audits, and analyse billing and claims data.
• Coordinate air and road evacuations, particularly from Mozambique to South Africa.
• Liaise with hospitals, service providers, and internal departments to align care and benefit utilisation.
• Monitor and report on healthcare trends, claims, and financial impacts.
• Willing to travel between Mozambique and South African and provider networks as required.

Minimum Requirements:

• Bachelor’s degree in Nursing, Healthcare Management, or related field is required.
• Active registration with the South African Nursing Council (if applicable).
• Minimum of 2 years’ case management experience within managed healthcare is essential.
• Proven experience in managing chronic conditions and hospital case reviews.
• Strong understanding of medical aid, risk principles, and regulatory compliance.
• Proficient in MS Office with excellent administration and coordination skills.

Competencies:

• Assertiveness
• Strong analytical, negotiation, and communication skills.
• Professionalism, empathy, and a client-centric mindset.
• Ability to work under pressure and solve problems proactively.
• High integrity and adaptability in a dynamic healthcare environment.

Why Join Us?

Mediplus SA offers a collaborative and purpose-driven work environment focused on improving member care while maintaining cost-effective solutions. This role is critical in ensuring the best care outcomes and financial sustainability for the organisation.

To apply, send your CV and qualifications to: [e-mail] with the subject line " your name - Clinical Case Manager"

Only shortlisted candidates will be contacted.