Hospital Case Manager

Mediclinic International; Randburg; On-site; ZAR 400 000 - 600 000; Full time

Job summary

A leading healthcare provider in Randburg seeks a Case Manager to coordinate clinical information and manage case processes, ensuring compliance with healthcare regulations. The candidate should be a Registered Nurse or qualified Paramedic with at least 3 years of clinical experience. Strong skills in clinical coding and medical terminology are essential, along with effective communication with funders. This permanent role is on-site.

Qualifications

• Minimum of 3 years in a clinical role is essential.
• Experience in private healthcare environment is desirable.
• Understanding of medical aid requirements is needed.

Responsibilities

• Coordinate hospital case management process.
• Ensure compliance to case management procedures.
• Communicate with funders as contractually agreed.

Skills

Understanding of anatomy

Clinical coding

Experience in Theatre or ICU

Use of electronic systems

Education

Registered Nurse / Professional Nurse or qualified Paramedic

Job description

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Mediclinic Sandton| Bryanston, Johannesburg | South Africa

Closing date: 17/11/2025

Number of positions: 1

Recruiter name: Nomsa Rachel Somzila

Reference number: 65080

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

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