89 Casemanagement jobs in South Africa

Case Manager – Medical Sector - Permanent Position
Do you thrive at the intersection of clinical care and coordination?
Are you passionate about ensuring patients receive the right support at the right time?
Then our client wants you on their team.

? Location: Pretoria ? Full-time

PLEASE NOTE THAT NO CV'S WILL BE KEPT FOR FUTURE USE . ONLY APPLY IF YOU QUALIFY IN FULL.


Introduction
Our client is an accredited managed health organisation that service clients in the medical scheme industry.
They are privileged to have one of the growing medical schemes in South Africa as a client and an opening exists for an experienced hospital benefit management case manager to join their team to support the growth in scheme membership.

Purpose of the position

• To actively manage the clinical appropriateness and risk (both financial and clinical) of all hospital events and associated healthcare services in accordance with the relevant scheme rules, clinical protocols and funding guidelines.
• To participate in the clinical review of exceptional cases and to engage with various stakeholders including treating providers, hospital case managers, medical advisors and colleagues.

• Registered Nurse
• Valid registration with SANC (please supply copy of current registration/ receipt)

• 3 to 5 years’ experience within a managed healthcare or medical scheme environment
• Thorough, well-grounded clinical knowledge of hospital admissions, Length of Stay and Level of Care
• Excellent knowledge of the South African Healthcare industry and prevailing legislation, current coding structures i.e. ICD10’s, CPT4, NRPL, PMB conditions and clinical protocols
• Extensive clinical knowledge related to all aspects of patient management
• Solid understanding of value-based care
• Demonstrated ability to manage a portfolio of hospital cases
• Outcome focused with the ability to manage competing demands
• Establishing and maintaining effective relationships with key stakeholders.
• Ability to accurately update and maintain cases information.
• Excellent telephonic and written communication skills (will be tested)
• Computer literate – MIP/ Medcaps Application System (knowledge/ experience will be advantageous) and MS Office Suite of Products
• Reporting – MS Excel basic knowledge required (will be tested)
• Proficiency in English – verbal and written
• Verbal proficiency in additional languages will be advantageous
• Compassionate and attentive listener – you will need to interact with the family/ loved ones of members with long-stay hospital events
• Demonstrated ability to effectively deal with emotionally charged and stressful situations
• Self-motivator and the ability to work effectively in an independent environment
• Strong organisational and task prioritisation skills
• Outstanding multitasking skills
• Ability to research and analyse information
• High degree of accuracy and attention to detail
• Maintaining confidentiality of information
• Knowledge of medical aid policies and procedures
• Decision making skills
• Following through on commitments
• Flexibility to travel and a valid driver’s license
• Hospital case management experience will be advantageous
• Nursing experience in an ICU setting will be a big advantage.

• Perform Clinical coding in accordance with CPT and ICD requirements and as per client standards
• Maintaining patient’s clinical status in accordance with funder approval requirements for the duration of hospitalisation; keeping patients informed and managing the entire hospital stay’s financial risk
• Provide complete and accurate updates and discharge information
• Receive hospital updates and assess each case based on clinical information – allocation of appropriate Length of Stay if clinically necessary
• Update Level of Care based on clinical information
• Review the costs to ensure cost effective and necessary care; balance cost and effectiveness of treatment to reduce re-admission
• Investigate and prepare cases for communication to the medical advisors, scheme, providers and members
• Member management of hospitalised patients with Chronic conditions who are registered on the active disease management programmes.
• Facilitation of the chronic and active disease registration of hospitalised beneficiaries who are diagnosed with one or more CDL conditions
• Escalation and resolution of unresolved high-cost cases
• Identification and preparation of high cost / high risk incidents and reported weekly to Clinical Specialist
• Discharge planning
• Communication with and support to Medical Advisors
• Call and written contact with Members and Providers
• Follow up on active cases with service providers relating to funding levels and updates (daily)
• Interpretation of medical reports
• Clinical decision making

Desired Skills:

• Valid registration with SANC
• MIP/ Medcaps Application System
• Microsoft Office Suite

A vacancy exists for the position of Case Management Officer in the Compliance Department of the National Bargaining Council for the Clothing Industry in the KZN Regional Chamber (KZN).

The successful applicant must have a thorough knowledge of the Labour Relations and the Basic Conditions of Employment Acts, including a thorough understanding of Collective Agreements. A good knowledge of CCMA rules and procedures is also required. The incumbent must be fully computer literate in all Windows packages (Word/Excel/Access/PowerPoint). Excellent communication skills, both verbal and written, are a must.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

• Administer the case management system for Non-Compliance enforcement ULP/Dismissal matters.
• Receive all dispute referral forms including applications for conciliation, arbitration, condonation, and non-compliance.
• Book days for conciliations/arbitrations to take place.
• Make bookings for venues in Isithebe and South Coast, Port Shepstone.
• Liaise with different CCMA branches to ensure the Clothing jurisdiction and transfer of cases to the Council.
• Check the time limits and jurisdiction before accepting applications.
• Send out notices to both parties via e-mail, fax, or registered post.
• Negotiate dates with arbitrators for arbitration hearings.
• Ensure the booking of interpreters for all arbitration hearings.
• Follow up on arbitration hearings and update both parties via e-mail.
• Update the case management system timeously.
• Send out notices advising of postponements and re-schedule diary accordingly.
• Apply for CCMA subsidy on a monthly basis.
• Process condonation applications and forward outcomes to the parties.
• Record every application referred to the Chamber on the case management program.
• Ensure compliance orders are set for arbitration timeously.
• Prepare necessary documentation for Section 143 applications to the CCMA for ULP matters.

OTHER DUTIES AND RESPONSIBILITIES

• Collect new exemption applications for the exemption committee and ensure all necessary documentation is attached.
• Compile compulsory quarterly reports for the CCMA for accredited Councils for the region and submit to the Head office.
• Draft compliance orders for inspectors.
• Keep record of compliance orders sent out.
• Scan all documents onto the Case system.

CVs containing references should be addressed to The Secretary - KZN Chamber.

Please note the closing date for applications is 12 April 2024.

Reference: PE000174-HP -2

The hiring organisation offers a minimum six-month fixed term contract opportunity to an experienced Registered Nurse with private hospital nursing experience.
Ideally you will be based in Port Elizabeth, EC but the possibility exists of a candidate being based in Durban, Bellville or Centurion.

ROLES AND RESPONSIBILITIES:

• Review of in-hospital patients for appropriateness of care, length of stay and level of care.
• Liaise with the service provider on clinical updates, as well as outstanding information.
• Engage with the treating doctor(s) to ensure appropriate treatment, length of stay and level of care is rendered.
• Discharge planning for in-hospital patients to ensure ongoing support and care post discharge.
• Develop, implement and communicate the practice and/or clinical guidelines for cost effective care.
• Authorise appropriate and cost-effective surgical care and treatment.
• Ensure the consistent and correct application of exclusions.
• Adhere to policies and procedures and take corrective action where necessary.
• Adhere to organisational best practice and legislative requirements.
• Take ownership of escalated and unresolved queries and ensure they are resolved timeously.
• Manage queries until resolution and update the incident details.
• Identify financial and business risks to the company and escalate accordingly.
• Provide clinical support to non-clinical team’s if/when required.
• Drive and support effective teamwork within the department.
• Strive to demonstrate the company's values daily.
• Engage in hospital visits where needed to build stakeholder relationships, proactively resolve queries and increase visibility to members.
• Ensure the effective, accurate and timeous completion of relevant documentation and recording of interventions.
• Communicate with providers to improve the cost efficiencies of health care delivery.
• Ensure Service Level Agreements are met and exceeded.
• Continuously develop own expertise in terms of industry and subject matter development and application thereof in an area of specialisation.

QUALIFICATIONS AND EXPERIENCE:

• Matric essential.
• Nursing Diploma or Degree essential.
• Minimum of 2 years clinical experience within a private hospital is essential.
• Must be registered with SANC (South African Nursing Council) as a Registered Nurse.
• A certificate in ICD-10 coding is highly advantageous.
• Experience in a managed care / case management environment would be an advantage.
• MS Office / Office 365 proficiency.
• Fluent in English – essential requirement.
• Open to SA citizens with a clear criminal and credit history.
• Valid unendorsed Driver’s License is essential, with own vehicle (preferred).

IMPORTANT ATTRIBUTES:

• Effective communication skills – verbal and written.
• Accountability.
• Planning and organising.
• Problem solving.
• Time management.
• Attention to detail.
• Interpersonal skills.
• Customer orientation.
• Results driven.
• Empathetic nature.
• Business Administration skills.

Location: Port Elizabeth, Centurion, Durban or Bellville
Profile: Health Care Services
Career Level: 2+ years.
Employment: Contract, six Month FTC
E.E. / Non-EE: Strictly EE (ACI, Males and Females)
Working Hours: Monday to Friday. 08H00 - 17H00
Remuneration: Market related basic.

Short listed candidates may be expected to complete and pass assessments before moving to the next stage of the recruitment process.
Should you not be contacted within two weeks, please consider your application unsuccessful.

Join to apply for the Case Manager role at Clinix Health Group (Pty) Ltd .

Job title: Case Manager

Location: Gauteng, Soweto

Deadline: June 06, 2025

Job Description:

• Plan, coordinate, and execute case management work at hospital level, utilizing clinical knowledge to minimize financial risk and ensure accurate billing through comprehensive coding of patient care.

Minimum Requirements:

• Relevant Nursing qualification.
• Experience as a CM or Billings Clerk with ICD training and anatomy & physiology certification.
• Knowledge of IDC and CPO coding.
• 3-5 years’ experience as a hospital case manager.

Key Responsibilities:

• Liaise with Receptionist for authorizations.
• Ensure compliance with case management procedures, standards, and protocols.
• Coordinate and execute clinical coding according to standards.
• Accurately code patient records.
• Communicate with Funders regarding authorizations, updates, and patient status.
• Provide clinical information to Funders to facilitate reimbursement.
• Consult with healthcare providers regarding patient treatment.
• Maintain patient clinical status during hospitalization.
• Manage patient accounts for reimbursement.
• Finalize cases timely for reimbursement.
• Manage hospital stay to minimize financial risk.
• Follow escalation processes for payment declines.
• Meet targets for WIP and DNYB.

• Seniority level: Mid-Senior level
• Employment type: Full-time
• Job function: Other
• Industry: Hospitals and Health Care

This job is active and accepting applications.

• Manage a portfolio of client cases of either work or non-work injury claims
• Manage injury claims to meet the Client Service Level Agreements, ACC Audit Standards, legislation and Wellnz’s commitment to quality
• Set clear expectations on what can be supported under the ACC Legislation
• Identify new business opportunities
• Regular progress reporting
  
  

• A competitive market salary with annual performance reviews + matched KiwiSaver up to 4%
• Corporate Discount programme
• Subsidised Southern Cross Health insurance and access to MyCare (for the best Doctors)
• Life and Salary Continuance insurance
• Wellbeing programmes and Wellbeing Days
• Annual flu Vaccinations
• Fruit baskets
• Modern CBD offices
• Great team environment with energetic and supportive colleagues
• Opportunities to learn and grow as a professional
• Paid parental leave
• Additional Lifestyle Leave
• Volunteer Leave
  
  

• Experience in injury rehabilitation case management or equivalent experience in a relevant health discipline
• Relevant tertiary qualifications in business and/or rehabilitation or health-related discipline or relevant working experience
• Thorough knowledge and understanding of the ACC Accredited Employer Programme (AEP)
• Strong clinical and ACC Legislative knowledge
• Proven effective communication, interpersonal, relationship and leadership skills
• Negotiation skills and ability to resolve conflicts
• Sensitivity to equity, culture and disabilities
• Proven time management and organisational skills, including the ability to prioritise to meet deadlines and work under pressure
• Self-motivation, energy and confidence to work independently
• Ability to travel domestically on occasion
  
  

• Qualified Registered Nurse,
• Registration with SANC and proof of indemnity cover,
• Minimum 2 years experience,
• Previous experience in a private hospital would be advantageous,
• Knowledge of ICD 10 and CPT coding,
• Knowledge of Prescribed Minimum Benefits (PMB) Scheme rules and policies,
• Medical-aid background in Case Management Department,
• Excellent communication skills (written and spoken),
• Excellent analytical and problem-solving skills,
• Excellent MS Office computer skills, i.e. Outlook, Word, Excel, Clinic Manager, etc.
• Attention to detail and ability to cope well under pressure

Job Summary:
Case Manager
Clinix Dr SK Matseke Memorial and Tshepo – Themba hospitals
Patient Services Manager
To plan, coordinate and execute case management work at hospital level. The incumbent utilises clinical
knowledge to minimise financial risk and ensure accurate billing through comprehensive accurate coding
of patient care.
This is a short-term contract position, to begin in May 2025.
Minimum Requirements:
• Diploma in Nursing
• 5 years’ experience as a hospital case manager
• Knowledge of ICD-10 and CPT Coding
• Knowledge of private health care operations
• Attention to detail and ability to confirm accuracy of files
Minimum work experience:
• Ensure compliance to case management procedures, standards and protocols.
• Plan, coordinate and execute Clinical coding in accordance with relevant CHG standards and
protocols.
• Timeously and consistently communicate and follow up with Funders (Medical Aids, COID,
Government, RAF, DOL, etc.)
• Provide appropriate clinical information to Funders in order to update Length of Stay, Level of
Care, formulary utilisation, assistive devices / Prosthesis, diagnostic interventions, therapy
intervention and procedural interventions and any required changes in patient treatment.
• Investigate and understand Funder, Doctors, Nurses and Patient needs to enable delivery of a
quality service.
• Ensure timeous resolution of stakeholder queries and complaints and take ownership of case
management and reimbursement related issues.
• Escalate potential risks that may lead to increased costs or financial losses.
• Maintain accurate records of patient care and timeously submit to funders to ensure the
organisation is appropriately reimbursed for all services rendered.
• Liaise with the Billing department with regards to conversion of medical aid patients to cash
patients.
• Adhere to statutory standards, policies and procedures within the business unit to ensure
compliance at all times and take remedial action where necessary. 

• Assess patient conditions and needs to develop appropriate care plans
• Interact with patients and medical aid schemes
• Resolve patient and medical aid scheme queries
• Update all information timeously and accurately
• CPT and ICD coding
• Obtain doctors letters, motivations, and justifications in all appropriate cases under managed care of where medical aids request them from their hospitals as part of their assessing process
• Monitor patient admissions and identify those who have limitations, restrictions, place by their managed care/ medical aid structures e.g. length of stay, cost restrictions, fixed fees, per diem and other limiting fees or drugs and/ or formularies
• Maintain a control system that ensures the systematic monitoring of managed care patients
• Handling patient queries
• Update hospital information

• Qualified Registered Nurse
• A qualified EN with relevant experience would be considered
• Both need to registered with SANC and proof of indemnity cover

• Minimum 3 years nursing experience in a multidisciplinary hospital.
• Experience and exposure in Theatre and/or ICU would be advantageous
• Hospital or Medical Aid scheme case management would be an advantage.
• Experience in ICD 10 and CPT coding is essential
• Knowledge of Prescribed Minimum Benefits (PMB) Scheme rules and policies
• Excellent communication skills (written and spoken)
• Excellent analytical and problem-solving skills
• Excellent MS Office computer skills, i.e. Outlook, Word, Excel, Kronos, Clinic Manager, etc.
• Attention to detail
• Ability to cope well under pressure

• Minimum: Grade 12 or equivalent NQF level 4
• Minimum: Basic Life Support accreditation / equivalent
  
  

• Minimum of 2 years’ working experience in relevant field
• Call center experience will be an advantage
• Medical and Insurance background will be an advantage
  
  

• Strong clinical background
• Excellent telephonic and written communication skills
• Multilingual
• Proficiency in Microsoft Office suite
• Knowledge of local medical aid and medical insurance and international patient case management principles and healthcare management
• Short-Term Insurance principles and workings
  
  

• Provide compassionate, caring and friendly care and guidance to clients.
• Coordinate emergency medical services.
• Coordinate GP, emergency room and hospital pre-authorization.
• Facilitate health advisory services according to prescribed protocols.
• Facilitate counseling services according to prescribed protocols.
• Coordinate international case management, medical repatriations and the repatriation of mortal remains.
• Adjudicate cases as per product benefits, limits and conditions.
• Maintain detailed and accurate records of client interactions, appointments, and treatment outcomes.
• Facilitate the repatriation of mortal remains.
• Administrative tasks.
• Call taking and other ad hoc duties.
  
  

• Showing Composure: Remains calm and does not get anxious before or during important events. Works well under pressure.
• Examining Information: Analyses and processes information very effectively when solving problems. Very curios and good at asking probing questions.
• Conveying Self Confidence: Self-confident and positive about themselves. Strong sense of own worth and feels in control of their future.
• Documenting Facts: Communicates well in writing, readily understand the logic behind an argument and will ensure that all the relevant facts are taken into consideration.
• Checking Things: Very thorough and even perfectionistic, ensures that things are done properly, delivering high quality work with great attention to detail.
• Producing Output: Works at a fast pace, works well when busy and copes well with multi-tasking.
• Managing Tasks: Very effective at planning and organizing, identifies clear priorities and milestones.
• Articulating Information: Is articulate in giving presentations; is eloquent and explains things well; projects social confidence when articulating information.
• Following Procedure: Extremely rule following, procedural and risk averse.
• Understanding People: Good at listening and understanding how others are feeling and why people behave as they do. Is attentive and understands what motivate others.