SUMMARY: Case Manager - Rehabilitation Centre
POSITION INFO:
Location: Durban, KwaZulu-Natal
Our client, a leading non-profit medical scheme, is seeking a dynamic and experienced Case Manager to join their physical rehabilitation hospital team. This role is ideal for a compassionate healthcare professional with strong clinical coding skills and a passion for patient advocacy and cost-effective managed care.
Conduct clinical assessments of patients referred for admission, including on-site visits to hospitals.
Build and maintain professional relationships with referring doctors, hospitals, and medical aid stakeholders.
Manage and oversee all billing processes, ensuring accuracy and compliance with medical aid requirements.
Submit and motivate for pre-authorisations and ex gratia benefits with medical schemes.
Collaborate with therapists, doctors, and the nurse manager to develop and monitor care plans.
Provide effective risk management to reduce hospitalisation costs while ensuring quality patient care.
Deliver cost-effective managed healthcare services to maximise member satisfaction.
Stay updated through ongoing training and development to maintain CPD compliance and clinical coding standards.
Registered Nurse (SANC) or Physiotherapist with valid professional registration.
Qualification or solid working knowledge in ICD-10 and CPT coding.
Minimum 5 years’ clinical experience, preferably in Trauma, ICU, or Theatre.
Strong ability to build and maintain relationships with doctors and healthcare professionals.
Proficiency in MS Office Suite and hospital billing systems.
Excellent English and Afrikaans communication skills (verbal and written).
Valid driver’s license and own transport (travel to hospitals required).
Strong organisational skills and attention to detail with the ability to prioritise effectively.
Excellent problem-solving techniques and a caring, patient-focused attitude.
Leadership skills with the ability to take responsibility and work collaboratively in a multidisciplinary team.
Flexibility to adapt to change and support management decisions to achieve common goals.
Market-related, commensurate with experience.
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