Hospital Case Manager

Mediclinic; George; On-site; ZAR 300,000 - 460,000; Full time

Job summary

Mediclinic George in George, South Africa seeks an experienced case management coordinator to optimise the hospital's case workflow and facilitate timely communication among clinicians, funders, and administration. You will ensure accurate clinical information, adherence to coding guidelines, and support the team to minimise financial risk and secure reimbursements.

The role requires nursing or clinical qualifications and several years of clinical experience.

Qualifications

• Essential clinical qualification and regulatory compliance knowledge.
• Nursing registration or paramedic qualification preferred for improved scope.
• Experience with funder contracts and medical aid narrations.

Responsibilities

• 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).

Skills

Anatomy terminology

Funder contracts

Patient admin programmes AS400

Scientific nursing principles

Microsoft Office

Authorization of Level of Care

Length of Stay

Short payments

Consumer protection act

Patient confidentiality policies

Education

Clinical qualification

Registered Nurse / Professional Nurse or qualified Paramedic

Tools

AS400 system

Microsoft Office

Job description

Mediclinic George | George | South Africa

Closing date: 06/11/2026
Number of positions: 1
Reference number: 74833
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

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 (including terminology)
• Funder Contracts; Medical aid requirements/narrations
• Patient admin programmes on the AS400 system
• Scientific nursing principles and process
• 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

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.