Hospital Case Manager

Medi Clinic; Cape Town; On-site; ZAR 300 000 - 600 000; Full time

Job summary

An established industry player is seeking a dedicated Case Manager to coordinate hospital case management and facilitate communication among all stakeholders. This role involves minimizing financial risks through effective patient stay management and ensuring compliance with case management procedures. The ideal candidate will possess a clinical qualification, with a strong background in nursing or paramedic services, and will be responsible for leading a team while adhering to clinical coding standards. Join a forward-thinking organization where your contributions will significantly impact patient care and operational efficiency.

Qualifications

• Minimum of 3 years in a clinical role is essential.
• Experience in Theatre or ICU and private healthcare is desired.

Responsibilities

• Coordinate hospital case management and ensure compliance with procedures.
• Manage patient stay to minimize financial risk for the organization.
• Lead the Case Management team and communicate effectively with funders.

Skills

Anatomy

Physiology

Medical terminology

Funder Contracts knowledge

B2B EMS

Microsoft Office

Clinical coding standards

Patient Administration policies

Education

Clinical qualification

Registered Nurse / Professional Nurse

Qualified Paramedic

Tools

AS400 system

Job description

Mediclinic Milnerton | Milnerton, Cape Town | South Africa

Closing date: 23/04/2025
Number of positions: 1
Recruiter name: Moegamad Magadie Martin
Reference number: 59461
Workplace Type: On-site
Permanent

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

1. Minimise financial risk by effectively managing patient stay.
2. Ensure compliance to case management procedures, contracts and legal aspects by utilising available resources and systems.
3. Ensure correct and timeous finalisation of cases to facilitate reimbursements from funders of claims.
4. Consistently and timeously communicate with Funders as contractually agreed through the relevant case management channels.
5. Ensure clinical coding standards are adhered to as per Level 3 coding guideline.
6. Lead and manage the people in the Case Management team (if applicable).

REQUIRED EDUCATION

ESSENTIAL EDUCATION: Clinical qualification

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

• Anatomy; physiology and terminology
• Funder Contracts; Medical aid requirements/narrations
• Scientific nursing principles and process
• B2B EMS (electronic message system: check status of authorisations and use for troubleshooting)
• Computer literate (Microsoft Office)
• Authorisation and motivation of Level of Care; Length of Stay; Short Payments etc.
• 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; coding; and case management processes
• Application of clinical codes and finalisation thereof (Level 3 coding)
• Patient admin programmes on the AS400 system

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.