Hospital Case Manager

Mediclinic Group; Emfuleni Local Municipality; On-site; ZAR 300,000 - 500,000; Full time

Job summary

Mediclinic Group is seeking a Hospital Case Manager to oversee the hospital case management process, ensuring proper patient stay management and compliance with case management protocols. This role requires a clinical qualification and substantial experience in a healthcare environment, focusing on minimizing financial risks and ensuring timely communication with funders.

Qualifications

• Minimum of 3 years in a clinical role required.
• Experience in Theatre or ICU is a plus.
• Knowledge of medical aid requirements and patient administration.

Responsibilities

• Coordinate hospital case management process.
• Manage patient stay to minimize financial risk.
• Ensure compliance with legal and procedural standards in case management.

Skills

Anatomy

Funder Contracts

Scientific nursing principles

Computer literate

Patient Administration policies

Education

Clinical qualification

Registered Nurse / Professional Nurse

Qualified Paramedic

Tools

Microsoft Office

Patient admin programmes on AS400 system

Job description

Important Notice

Mediclinic wants to alert candidates that third parties are from time to time fraudulently advertising vacancies at Mediclinic and / or offering employment contracts with subsequent payment instructions to accounts linked to the fraudulent activity. Please note that Mediclinic will never request payment for an application or offer made. All official vacancies are advertised on the Mediclinic career website and candidates are advised to visit the site to confirm the validity of vacancies.

Hospital Case Manager

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Mediclinic Emfuleni | Vanderbijlpark, Emfuleni | South Africa

Closing date: 29/06/2025

Number of positions: 1

Recruiter name: Matshidiso Gladys Tsoari

Reference number: 61431

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

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