Hospital Case Manager

Mediclinic International; Noord-Kaap; On-site; ZAR 300,000 - 420,000; Full time

Job summary

Mediclinic Gariep in Kimberley, South Africa is recruiting a Case Management Coordinator to oversee hospital case management, ensuring timely information flow between clinicians, funders and payers to minimise financial risk. The role requires a clinical background (nursing or paramedic), with essential experience in a private healthcare setting and proficiency in coding and contract compliance.

The successful candidate will coordinate workflows, support the team, and ensure accurate processing

Qualifications

• Minimum 3 years in a clinical role.
• Experience in Theatre and/or ICU preferred.
• Experience in private healthcare or with ILS/ALS Paramedic backgrounds.

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 timeous finalisation of cases to facilitate reimbursements from funders of claims.
• Communicate with Funders timeously and in accordance with case management channels.
• Adhere to Level 3 coding guidelines for clinical coding.
• Lead and manage the Case Management team where applicable.

Skills

Anatomy & physiology

Medical terminology

Funder contracts

Medical aid requirements

Clinical coding

Level of care authorization

Length of Stay optimization

Electronic systems (B2B portals)

Statutory acts knowledge

Patient administration policies

Education

Registered Nurse / Professional Nurse or Paramedic

Job description

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Mediclinic Gariep| Kimberley | South Africa

Closing date: 30/09/2026
Number of positions: 1
Recruiter name: Portia Mabunda
Reference number: 73714
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

• 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