Hospital Case Manager

Mediclinic Group; Sandton; On-site; ZAR 350 000 - 450 000; Full time

Job summary

A prominent healthcare group in Sandton seeks a Hospital Case Manager to coordinate the case management process and minimize financial risk. The role demands a clinical qualification and experience in a clinical environment. Applicants must effectively manage patient stays and communicate with funders. Competitive package offered, applying now.

Qualifications

• Minimum of 3 years in a clinical role required.
• Experience in Theatre/ICU or private healthcare is beneficial.

Responsibilities

• Coordinate the hospital case management process.
• Manage patient stay to minimize financial risk.
• Ensure compliance with case management procedures.

Skills

Understanding of anatomy

Funder Contracts

Scientific nursing principles

Use of electronic systems

Computer literacy

Education

Clinical qualification

Registered Nurse / Professional Nurse

Tools

Microsoft Office

hospital/practice management systems

Job description

Important Notice

Mediclinic wants to alert candidates that third parties are from time to time 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.

Hospital Case Manager

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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

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: Clinical qualification
• Desired: 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

EEO Statement

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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Job Segment: Nursing, Registered Nurse, Case Manager, Compliance, Paramedic, Healthcare, Legal

Job Type: Administration