Hospital Case Manager

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

Job summary

A leading healthcare provider in Milnerton seeks a qualified Registered Nurse or Paramedic to coordinate clinical case management, ensuring compliance with procedures and minimizing financial risks. The ideal candidate has at least 3 years of clinical experience, preferably in Theatre or ICU, and possesses strong understanding of medical terminology and case management systems. The role also includes managing communications with Funders for claims reimbursements. Join a collaborative team dedicated to patient care and financial efficiency.

Qualifications

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

Responsibilities

• Coordinate hospital case management process to minimize financial risk.
• Ensure compliance to case management procedures and contracts.
• Communicate with Funders regarding claims and reimbursements.

Skills

Understanding of anatomy

Scientific nursing principles and process

Use of electronic systems

Clinical coding

Authorisation and motivation of Level of Care

Education

Registered Nurse / Professional Nurse or qualified Paramedic

Job description

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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:[[cust_WorkplaceType]]
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

• 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)
• 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

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