Professional Nurse (Case Manager)

Department of Health; Boksburg; On-site; ZAR 304,000 - 371,000; Full time

Job summary

Department of Health in Gauteng seeks an experienced Professional Nurse with SANC registration to perform complex case management and discharge planning in a hospital setting.

Requirements include a Diploma in Nursing, Grade 12, and 3–5 years of clinical nursing experience, plus knowledge of health legislation and PMB/UPFS regulations. Proficiency in MS Word/Excel and strong communication are essential, with the ability to work under pressure.

Qualifications

• Grade 12 and a Diploma in Nursing with SANC registration as a Professional Nurse.
• 3–5 years of relevant clinical nursing experience.
• Knowledge of health care legislation and regulations (National Health Act, PFMA, PMB Regulations, UPFS).
• Computer literacy with MS Word and MS Excel.
• Strong planning, organization, coordination and communication skills; report-writing ability.

Responsibilities

• Perform case management including pre-authorization and discharge planning.
• Assist with medical aid rejection reports and resubmissions.
• Coordinate with clinicians, managed care orgs and case managers to monitor utilization.
• Develop and implement case management policies and procedures in the hospital.
• Audit patient accounts and educate staff on charge sheets and coding.

Skills

Nursing

SANC Registered Professional Nurse

Clinical case management

MS Word

MS Excel

Communication skills

Report writing

Education

Diploma in Nursing (R171/R425)

Tools

MS Office Suite

Job description

• Package : R 337 359.00 per annum (plus benefits)
• Enquiries : Ms. S Mokoena Tel: [phone]

Requirements :

• The applicant must be in possession of a Grade 12 Certificate and a Diploma in Nursing (R171) or Diploma in Nursing (R425), or an equivalent nursing qualification, with current registration with the South African Nursing Council (SANC) as a Professional Nurse. The applicant must have 3–5 years’ relevant clinical nursing experience and knowledge and understanding of applicable healthcare legislation, policies and regulatory frameworks, including the National Health Act, Public Finance Management Act (PFMA), Medical Schemes Act, Prescribed Minimum Benefits (PMB) Regulations, Uniform Patient Fee Schedule (UPFS) and relevant Department of Health policies and procedures. Knowledge of ICD-10 and procedure coding will be an added advantage. The applicant must be computer literate, with proficiency in Microsoft Office, particularly MS Word and MS Excel. The applicant must be a driven, accountable and customer-focused individual with good planning, organizing, coordination, communication and report-writing skills. Good interpersonal relations, customer service and training skills are essential, together with the ability to work independently, effectively within a multidisciplinary healthcare environment and under pressure.

Duties :

• Perform Case Management functions, i.e. obtaining pre-authorization and verification of benefits as needed, concurrent, retrospective review, discharge planning and provide quotations to H2, H3 and foreign patients. Assist with Medical Aid rejection reports and ensure corrections are completed timeously and resubmitted to Medical Aid. Liaise with the various role-players e.g. clinicians, managed care organizations and medical scheme case managers to monitor utilization and update patient’s clinical information while in hospital. Manage and implement case management policies, protocols and procedures in the hospital. Conduct clinical audits of patient accounts inclusive of medical aids, state departments e.g. RAF and COIDA to ensure accuracy of invoices aboutICD 10 codes, UPFS procedure codes and resource utilization. Manage and supervise Case Management and Revenue departments. Manage performance and development of staff. Application of clinical knowledge in the risk management (financial and clinical) of patients in terms of Length of Stay (LOS), Level of Care (LOC), clinical updates, ICD 10 Coding, procedure coding and cost benefits available, identification of billable services, treatment care plans, chronic disease case management and discharge planning. Audit patient’s accounts, train hospital officials on the utilization of charge sheet, and keep electronic and physical records.

Employer : Department of Health

Closing Date : 07-10-2026

Criteria Questions

Do you have a Diploma/ Degree in General Nursing Science or equivalent qualification that allows registration as a Professional Nurse?

Do you have a minimum of 3 years appropriate clinical Nursing experience after registration as a Professional Nurse?

Do you have a knowledge and understanding of applicable health care legislations, policies and regulatory frameworks, such as; PFMA, Medical Scheme act, PMB Regulations and UPFS?

Are you currently registered with SANC for 2026?

The Gauteng Department of Health is guided by the principles of Employment Equity. People with disabilities are encouraged apply.