Hospital Case Manager

Medi Clinic; Milnerton; On-site; ZAR 350 000 - 500 000; Full time

Job summary

A healthcare facility in Milnerton seeks a professional to coordinate case management processes, ensuring compliance and communication among stakeholders. Candidates should have a clinical qualification with a minimum of 3 years in a clinical role. Experience in Theatre, ICU, or private healthcare is preferred. Strong knowledge in clinical coding and financial risk management is essential. This is a permanent position offering a chance to impact patient care and safety.

Qualifications

• Minimum of 3 years in a clinical role required.
• Experience in Theatre and or ICU desired.
• Medical aid background preferred.

Responsibilities

• Coordinate the hospital case management process.
• Minimise financial risk by managing patient stay.
• Ensure compliance to case management procedures.

Skills

Understanding of anatomy

Funder Contracts knowledge

Computer literacy

Clinical Coding application

Education

Clinical qualification

Registered Nurse / Professional Nurse or qualified Paramedic

Tools

Microsoft Office

Hospital/practice management systems

Job description

Mediclinic Milnerton| Milnerton, Cape Town | South Africa

Closing date: 12/01/2026
Number of positions: 1
Recruiter name: Nico Andrew Theo Botha
Reference number: 65891
Workplace Type: 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

• 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