Clinical Case Manager

SUMMARY:
An exciting opportunity exists for a Clinical Case Manager to join a dynamic team. This role will provide oversight across the Group, ensuring effective patient case management and delivering a high standard of service to both internal and external stakeholders.
The ideal candidate is goal-driven, with a strong focus on patient outcomes, service excellence, and operational efficiency.

POSITION INFO:

Key Responsibilities

• Conduct clinical coding in line with CPT and ICD standards
• Validate pre-admission and pre-authorisation details in accordance with hospital and funder policies
• Monitor and manage patients' clinical status throughout their stay, ensuring ongoing funder compliance and financial risk mitigation
• Maintain accurate admission and discharge data, including real-time account updates
• Drive timeous electronic submission of accounts and resolve case management-related short payments
• Facilitate Case Management training initiatives across the Group
• Ensure all patient file handling complies with hospital protocols
• Support hospital teams in adhering to funder rules and coding standards
• Stay current on healthcare legislation and funder-related regulations

Minimum Requirements

• Registered with the South African Nursing Council (SANC)
• Matric/Grade 12 certificate
• 3–5 years' experience in basic finance and Medical Aid administration (advantageous)
• Familiarity with hospital billing systems and medical tariffs (preferred)
• Strong MS Office proficiency (Word & Excel)
• Willingness to travel as required
• Excellent communication and relationship-building skills
• Strong negotiation ability with professional tact and diplomacy

• Collaboration & Relationship Building
• Problem-Solving, Analysis & Judgement
• Resilience
• Engaging Diversity
• Verbal & Written Communication
• Influencing
• Customer Responsiveness
• Organisational Awareness
• Excellence & Quality Orientation
• Ethical Behaviour