Hospital Case Manager

Mediclinic International; Bloemfontein; On-site; ZAR 200,000 - 300,000; Full time

Job summary

A healthcare organization in Bloemfontein seeks a Case Manager to coordinate hospital case management and facilitate communications. The ideal candidate will be a Registered Nurse or qualified Paramedic with at least 3 years of clinical experience, preferably in a private healthcare environment. Responsibilities include managing financial risks, adhering to coding standards, and ensuring compliance with procedures. Permanent position with on-site workplace type.

Qualifications

• Minimum of 3 years in a clinical role is essential.
• Experience in Theatre or ICU is desired.
• Medical aid background is a plus.

Responsibilities

• Coordinate the hospital case management process to minimize financial risk.
• Ensure compliance to case management procedures.
• Communicate consistently with funders as required.

Skills

Understanding of anatomy

Funder Contracts knowledge

Scientific nursing principles

Clinical coding

Use of electronic systems

Education

Registered Nurse / Professional Nurse or qualified Paramedic

Job description

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Closing date: 07/08/2025
Number of positions: 1
Recruiter name: Boitumelo Edith Davids
Reference number: 62671
Workplace Type:On-site
Permanent

Please note if you are an internal employee on a fixed term contract please apply using an external candidate profile and not your employee profile

MAIN PURPOSE OF JOB

To coordinate the hospital case management process and facilitate the communication process between all role players by providing accurate and timeous clinical information to minimise the financial risk for the organisation.

KEY RESPONSIBILITY AREAS

Minimise financial risk by effectively managing patient stay

Ensure compliance to case management procedures, contracts and legal aspects by utilising available resources and systems

Ensure correct and timeous finalisation of cases to facilitate reimbursements from funders of claims

Consistently and timeously communicate with Funders as contractually agreed through the relevant case management channels

Ensure clinical coding standards are adhered to as per Level 3 coding guideline

Lead and manage the people in the Case Management team (if applicable)

REQUIRED EDUCATION

DESIRED EDUCATION: Registered Nurse / Professional Nurse or qualified Paramedic

REQUIRED EXPERIENCE

ESSENTIAL MINIMUM EXPERIENCE: Minimum of 3 years in a clinical role

DESIRED EXPERIENCE: Experience in Theatre and or ICU; Medical aid background; Experience in private healthcare environment or experience as an ILS/ALS Paramedic

REQUIRED JOB SKILLS AND KNOWLEDGE

• Understanding of anatomy; physiology and medical terminology
• Funder Contracts; Medical aid requirements/narrations
• Scientific nursing principles and process
• Authorisation and motivation of Level of Care; Length of Stay; Clinical Coding, high-cost stock, Short Payments etc.
• Use of electronic systems (i.e. B2B or Funder portals) for the purposes of requesting authorisations, performing case management updates and for troubleshooting)
• Relevant aspects of applicable statutory acts (e.g. Consumer Protection Act; PMB; etc.)
• Patient Administration policies and procedures (e.g. Patient Confidentiality; Visitation of external case managers; etc.)
• Daily workflow; managing deviances; clinical coding; and case management processes
• Application of clinical codes and finalisation thereof

All applicants will be considered, with the understanding that preference will be given in accordance with the Employment Equity Plan of Mediclinic Southern Africa, as well as internal applicants/employees that meet the minimum requirements.

Please note if you are an internal employee on a fixed term contract please apply using an external candidate profile and not your employee profile

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