Hospital Case Manager

Mediclinic Group; Milnerton; On-site; ZAR 200 000 - 300 000; Full time

Job summary

A leading healthcare provider in Milnerton seeks a Hospital Case Manager to coordinate the case management process. The role requires clinical qualifications and a minimum of three years in a clinical role. Responsibilities include managing patient stays, ensuring compliance to case management procedures, and facilitating communication with funders. Opportunities for career development in a supportive environment are provided.

Qualifications

• Minimum of 3 years in a clinical role.
• Experience in Theatre and/or ICU; medical aid background; private healthcare experience.

Responsibilities

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

Skills

Understanding of anatomy, physiology and medical terminology

Knowledge of funder contracts and medical aid requirements/narrations

Scientific nursing principles and processes

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

Education

Clinical qualification

Registered Nurse / Professional Nurse or qualified Paramedic

Job description

Important Notice

Mediclinic wants to alert candidates that third parties are 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.

Job Title

Hospital Case Manager

Location and Details

• Location: 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
• Internal employees on fixed‑term contract – please apply using an external candidate profile.

Main Purpose of the Job

To coordinate the hospital case management process and facilitate the communication process between all role players by providing accurate and time‑off clinical information to minimise the financial risk for the organisation.

Key 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 timely finalisation of cases to facilitate reimbursements from funders of claims.
• Consistently and timely 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: Clinical qualification.

Desired Education

• Registered Nurse / Professional Nurse or qualified Paramedic.

Required 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.
• Knowledge of funder contracts and medical aid requirements/narrations.
• Scientific nursing principles and processes.
• Authorisation and motivation of level of care; length of stay; clinical coding; high‑cost stock; short payments, etc.
• Use of electronic systems (e.g., B2B or funder portals) for requesting authorisations, performing case management updates and troubleshooting.
• Computer literacy (Microsoft Office, hospital/practice management systems).
• Relevant statutory acts (Consumer Protection Act; PMB; etc.).
• Patient administration policies and procedures (confidentiality; visitation of external case managers; etc.).
• Daily workflow; managing deviances; clinical coding; and case management processes.
• Application of clinical codes and finalisation thereof.

Other Information

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.