Hospital Case Manager

Mediclinic International; Mbombela; On-site; ZAR 200,000 - 300,000; Full time

Job summary

A healthcare organization is seeking a Case Manager to coordinate patient management processes and communicate with funders. Candidates must be a Registered Nurse or qualified Paramedic with at least 3 years of clinical experience. The role emphasizes managing patient stays to minimize financial risk and requires adherence to clinical coding standards. This is a permanent, on-site position located in Mpumalanga, South Africa.

Qualifications

• Registered Nurse or qualified Paramedic required.
• Minimum of 3 years in a clinical role is essential.
• Experience in Theatre, ICU or private healthcare preferred.

Responsibilities

• Coordinate the hospital case management process.
• Communicate with funders to minimize financial risk.
• Manage patient stay effectively.

Skills

Anatomy

Physiology and terminology

Funder Contracts

Medical aid requirements/narrations

Scientific nursing principles and process

B2B EMS

Clinical coding standards

Patient administration policies

Education

Registered Nurse / Professional Nurse

Qualified Paramedic

Tools

AS400 system

Job description

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Closing date: 05/08/2025
Number of positions: 1
Recruiter name: Nhlanhla Samaria Mahlangu
Reference number: 60529
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

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)
• 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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