Hospital Case Manager

Medi Clinic; George; On-site; ZAR 30 000 - 40 000; Full time

Job summary

A healthcare provider in George, South Africa is seeking a qualified Registered Nurse to coordinate the case management process. This role will involve managing patient stay, ensuring compliance with procedures, and communicating effectively with funders. The ideal candidate should have at least 3 years of experience in a clinical role, preferably in a private healthcare environment. This permanent position is on-site and offers an opportunity to lead case management efforts.

Qualifications

• Minimum of 3 years in a clinical role required.
• Experience in Theatre and or ICU preferred.
• Background in private healthcare desirable.

Responsibilities

• Coordinate the hospital case management process.
• Communicate effectively with Funders and manage patient stay.
• Ensure compliance to case management procedures.

Skills

Understanding of anatomy

Scientific nursing principles and process

Computer literacy (Microsoft Office)

Use of electronic systems for authorisations

Clinical coding knowledge

Education

Registered Nurse / Professional Nurse

Clinical qualification

Job description

Mediclinic George | George | South Africa

Closing date: 04/11/2025
Number of positions: 1
Recruiter name: Dalena Boshoff
Reference number: 64940
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: Registered Nurse / Professional Nurse

DESIRED EDUCATION: Clinical qualification

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

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)
• Computer literacy (Microsoft Office, hospital/practice management systems)
• 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