Hospital Case Manager

Medi Clinic; Durbanville; On-site; ZAR 300,000 - 500,000; Full time

Job summary

Mediclinic Durbanville seeks a Case Manager responsible for coordinating the hospital case management process, minimizing financial risks, and ensuring compliance with legal aspects. Candidates must have a clinical qualification and a minimum of three years' experience in a clinical role. Join a leading healthcare provider committed to high standards and effective patient management.

Qualifications

• Essential education includes clinical qualifications.
• 3+ years experience in a clinical role required.
• Desirable experience in Theatre/ICU and Medical aid backgrounds.

Responsibilities

• Minimise financial risk by managing patient stays effectively.
• Ensure compliance to case management procedures and finalisation of cases.
• Communicate consistently with funders through relevant channels.

Skills

Anatomy

Physiology

Medical aid requirements

Scientific nursing principles

Computer literacy

Education

Clinical qualification

Registered Nurse / Professional Nurse or qualified Paramedic

Tools

Microsoft Office

Job description

Mediclinic Durbanville| Durbanville, Cape Town | South Africa

Closing date: 18/06/2025
Number of positions: 1
Recruiter name: Monique Joy Hector
Reference number: 61154
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

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 trouble,shooting)
• 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.

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