Clinical Case Manager

Recruiter:

Immploy

Job Ref:

CPT003049/VR

Date posted:

Friday, May 30, 2025

Location:

GP, South Africa

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

Key Competencies

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

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