RELIEF CASE MANAGER

Joint Medical Holdings Group; Durban; On-site; ZAR 300,000 - 420,000; Full time

Job summary

Joint Medical Holdings Group is seeking a Relief Case Manager to support case management across hospital units, covering absences and periods of high workload. You will manage patient authorisations, monitor length of stay, and liaise with medical schemes to ensure continuous care and funding efficiency.

You will collaborate with clinical, billing and management teams to verify benefits, document activity and mitigate funding risks while maintaining accurate records and contributing to service

Qualifications

• Must have healthcare qualification (prefer Nursing or clinical discipline).
• Previous hospital Case Management experience is required.
• Experience with medical schemes and funders.
• Understanding hospital admission, authorization, LOS and discharge processes.
• Knowledge of medical aid rules and funding requirements.
• Computer literacy is essential.
• Sound knowledge of ICD-10 and clinical coding principles.

Responsibilities

• Provide case management support and cover across hospital departments to ensure continuity of service.
• Manage patient admissions, authorizations and length of stay in line with clinical and funding requirements.
• Liaise with medical schemes, funders and healthcare professionals to obtain and maintain authorizations.
• Monitor high-risk, high-cost and extended-stay patients, identifying potential funding risks and escalating where necessary.
• Track patient length of stay and support timely discharge planning to optimize patient flow.
• Ensure accurate management of patient funding, benefits verification and authorization processes.
• Identify and mitigate financial risks related to admissions, treatment and hospitalization.
• Collaborate with clinical, billing, debtors and hospital management teams to resolve funding and case management queries.
• Maintain accurate records, documentation and communication relating to patient cases and authorizations.
• Support operational priorities, workload management and service delivery within the Case Management Department.

Education

Healthcare qualification (Nursing or clinical discipline)

Job description

JOB DESCRIPTION

PURPOSE OF POSITION

The Relief Case Manager provides flexible support within the Case Management Departments by covering staff absences, vacancies and periods of increased workload. The role is responsible for managing patient authorisations, monitoring length of stay, liaising with medical schemes and funders, and identifying clinical and financial risks to ensure continuity of care, operational efficiency and optimal funding outcomes. The incumbent must be adaptable, able to work across multiple hospital units and specialties, and committed to delivering high-quality case management support.

KEY PERFORMANCE AREAS

• Provide case management support and cover across hospital departments to ensure continuity of service.
• Manage patient admissions, authorizations and length of stay in line with clinical and funding requirements.
• Liaise with medical schemes, funders and healthcare professionals to obtain and maintain authorizations.
• Monitor high-risk, high-cost and extended-stay patients, identifying potential funding risks and escalating where necessary.
• Track patient length of stay and support timely discharge planning to optimize patient flow.
• Ensure accurate management of patient funding, benefits verification and authorization processes.
• Identify and mitigate financial risks related to admissions, treatment and hospitalization.
• Collaborate with clinical, billing, debtors and hospital management teams to resolve funding and case management queries.
• Maintain accurate records, documentation and communication relating to patient cases and authorizations.
• Support operational priorities, workload management and service delivery within the Case Management Department.

MINIMUM REQUIREMENTS

• Relevant healthcare qualification, preferably in Nursing or another appropriate clinical discipline.
• Previous hospital Case Management experience.
• Experience working with medical schemes and funders.
• Understanding hospital admission, authorization, length of stay and discharge processes.
• Knowledge of medical aid rules and funding requirements.
• Computer literacy.
• Sound knowledge of ICD-10 and clinical coding principles.

ADVANTAGEOUS EXPERIENCE

• Experience across multiple hospital specialties.
• Experience in private hospital Case Management.
• Experience managing high-cost and complex patient cases.
• Experience with hospital information systems and case management systems.

NB: Only short-listed candidates will be contacted.

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Your information is collected and processed in accordance with the Protection of Personal Information Act No 4 of 2013 (POPIA).
By applying to this advert, you consent to JMH (Pty) Ltd collecting and processing your personal information for the purpose of determining your eligibility for the advertised position.
If unsuccessful, your personal information is securely destroyed and is not retained by the company.
Preference will be given to employees from the designated group in line with the Employment Equity Act.