24 Case Manager jobs in South Africa

• 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

Case Manager

Unity Health is a well-established primary healthcare provider in the South African market. Our mission is to offer primary healthcare insurance solutions to the vast majority of South Africans who are unable to afford medical scheme coverage. We have an opening for a Case Manager to join our Clinical team who will be the liaison between Unity Health, providers, and members.

Qualifications:

• Matric
• Registered Nursing diploma
• Valid membership of SANC
• RE5 (advantageous)

Skills and Experience:

• At least 2-3 years' experience in a similar role
• MIP Application System experience an advantage
• Sound understanding of the South African Health Industry, benefits, etc.
• ICD codes, modifiers and RPL tariff knowledge and understanding
• Ability to liaise with external parties – clinicians and members
• Ability to work within an established team
• Excellent oral and written communication skills
• Customer centric attitude
• Excellent analytical skills and pays attention to detail
• Computer literate - MS Office suite, i.e., Word, Excel
• A good understanding of claims risk profiling
• Experience in claims auditing.

Scope of Responsibility:

• Responsible for incoming calls from Hospitals Case Managers relating to authorisations for procedures in hospitals, casualty, doctors, or dental providers rooms
• Hospital case management from issuing a pre-authorisation letter to final discharge and any follow up treatment where required
• Manage clinical risk by promoting sound principles and strategies to decrease claims over utilisation
• Pre-authorisation of GP visits per benefit option rules
• Classify and prioritise risks based on the frequency of member visits to a provider
• Ensure efficient Customer Service and compliance to agreed SLA's
• Follow up with healthcare practitioners and members who may be over utilising
• Manage and maintain data integrity and update accordingly where necessary
• Ensure all enquiries are resolved satisfactorily and customer requirements within business rules and costing factors are maintained
• Weekly review of all approved claims and ensure that all claims are settled according to correct tariffs and procedures
• Ensure that all calls and cases are fully and clearly recorded on the MIP system
• Supply all monthly management reports on cases and general case management processes and initiatives
• Any other duties as assigned by your supervisor from time to time

Purpose

Deliver and enable excellence in all service moments to all stakeholders (Members, Providers, Employer groups, Intermediaries, Schemes). Personalised clinical servicing through the Omni channel experience focusing on the overall care quality of interaction between our customers and the brand. Providing holistic care that is personalised and accessible, managing the care journey end to end.

Experience:

Managed Healthcare Operations experience 2 years Advantageous

Clinical experience 3 years Essential

Qualifications

Bachelors Degree (3 years) / NQF level 7(Registered Nursing Qualification, plus registration with SA Nursing Council)

Diploma / NQF level 6(Registered Nursing Qualification, plus registration with SA Nursing Council)

4 year Degree / NQF level 7 Allied Healthcare professional. Relevant and active registration with regulatory body

Position Specific KPA

Manage Care Service Requests

Servicing all key stakeholders in the moment across all servicing channels as required until the clinical service request has been resolved.

Educating stakeholders on self-help digital servicing tools. Connecting with your customers (all stakeholders) across all channels, enabling an intuitive experience bringing across our brand authentically. Providing a seamless, progressive and holistic approach, understanding the customer's needs.

Manage authorizations

Manage and or validate the customer's authorizations needs with care, understanding and empathy. Caring holistically for the patient journey.

Manage Cases

Manage clinical cases enabling a holistic personalised intervention. Caring holistically for the patient and their support structure journeys.

Manage Excellent Experiences

Provide accurate and consistent information, meeting all quality standards and measures.

Deliver excellence in customer satisfaction.

Strive to identify areas of improvement and sharing of ideas with your team.

Collaborate with all teams to enable peer to peer learning

Drive Brand Loyalty

Being a brand ambassador, allowing the brand presence to be felt as an extension of the experience.

Knowledge

Advanced Health Care Industry

Advanced Good understanding of the Health Care Environment and Facilities

Advanced Health legislation and regulatory

Basic Application of service processes

Advanced Customer service

Advanced Customer preferences and personality styles

Technical

Basic Microsoft Suite

Basic use of technology

Basic channel experience

Turnaround Time

The shortlisting process will only start once the application due date has been reached. The time taken to complete this process will depend on how far you progress and the availability of line managers.

Our Commitment to Transformation

AfroCentric is committed to transformation and embracing diversity. Our Employment Equity plan and targets will be considered as part of the recruitment process. This commitment is what drives us to achieve a diverse workplace with employment equity as a key goal to create an inclusive workforce, representative of the demographics of our society as well as people with disabilities.

Should you not hear from us within a month of applying, consider your application unsuccessful
.

Responsible for application of clinical knowledge in justifying patient

hospitalisation in terms of treatment, length of stay and level of care

Monitor and action risk related to medical aid benefits and hospitalisation

Ensure accurate, specific and comprehensive clinical coding

Timeous, effective communication and follow up with medical aids

Review authorisation aspects approved, mitigating financial risk and final

releasing the case for billing

Liaise with a network of internal and external stakeholders regarding patient treatment

Adhere to the NHN Managed Health Care rules of engagement

Compliance with all industry relevant legislative acts, regulations and circulars

B Degree/Diploma Nursing qualification and/or Case Management qualification

Diverse clinical nursing experience

Case Management experience

ICD-10 / CPT Coding Qualification or Experience

SAP IS-H experience is advantageous

Proficiency in Microsoft Office products

Between 3 - 5 Years

Introduction and Purpose

Are you a clinically skilled professional with a passion for patient advocacy and healthcare coordination? We are building a
Talent Pool
of experienced
Case Managers
for future opportunities within our healthcare network. If you have a background in nursing, managed care, or hospital benefit management, we encourage you to apply and be considered for upcoming roles.

This is a general application to join our
Talent Pool
. By applying, you will be considered for upcoming
Case Manager
roles as they become available continuously.

Duties & Responsibilities

• Manage hospital admissions and clinical case reviews.
• Assess treatment plans and authorise appropriate levels of care.
• Liaise with healthcare providers, patients, and funders.
• Monitor high-cost and chronic cases for clinical and financial risk.
• Ensure compliance with scheme rules, clinical protocols, and funding guidelines.
• Prepare cases for medical advisor review and escalate where necessary.

Desired Experience & Qualification

Minimum Requirements:

• Registered Nurse (with valid SANC registration) or equivalent clinical qualification.
• 2–3 years' experience in
  Case Management
  ,
  Hospital Benefit Management
  , or
  Managed Care
  .
• Strong administrative and communication skills.
• Proficiency in MS Office and healthcare systems.
• Experience in trauma, surgical, or general wards.
• Familiarity with medical aid schemes and healthcare legislation.
• Previous work in a call centre or customer service environment.

Remote Case Manager (Property Finance) – UK Company | Based in South Africa

Role Details:

•
Location:
Remote, South Africa (UK working hours)

•
Employment type:
Full-time, permanent

•
Salary:
R20,000 - R25,000 Depending on experience

Ubuntu BPO is recruiting on behalf of our client, a leading UK property finance business, who are seeking a
Case Manager
to join their growing team.

The ideal candidate will be
highly organised, detail-driven, and experienced in financial administration
. If you have a background in
banking, finance, or insurance administration
, this is an excellent opportunity to take the next step in your career with an established UK company.

Key Responsibilities:

• Manage property finance cases from application through to completion.

• Communicate effectively with clients, lenders, and solicitors.

• Ensure all documents and compliance requirements are completed accurately.

• Track case progress and maintain clear, up-to-date records.

• Deliver excellent client service throughout the process.

Candidate Requirements:

• Minimum
2 years' experience
in
banking admin, finance admin, or insurance admin
.

• Strong organisational skills with the ability to handle multiple cases.

• Excellent written and verbal communication skills.

• Confident using Microsoft Office (Word, Excel, Outlook).

• Self-motivated, dependable, and able to work independently in a remote setting.

This is a fantastic opportunity to work with an ambitious UK business and build your career in property finance while working remotely from South Africa.

Our client, a non-profit, medical scheme is seeking a Case Manager HBM in the Pretoria area. Delivering of cost-effective managed healthcare service to accomplish member satisfaction.

Behavioural Competency

Strong organizational skills, attention to detail and ability to prioritize.

Strong communication skills in English and Afrikaans.

Ability to work in a team.

Caring attitude and behaviour.

Flexibility in adapting to change and management decisions to achieve common goals.

Excellent problem-solving techniques.

Leadership skills.

Taking responsibility.

Duties include the following, but not limited to:

Risk Management – to reduce the risk associated with hospital and authorized cases.

On-going training and development – to update knowledge and skills to deliver a cost-effective and professional service.

Case management of authorised cases according to the acceptable Scheme rules and protocols.

To reduce the risk associated with hospitalization and to provide an effective and unique managed healthcare.

Cost per beneficiary

Effective Customer Service delivery.

To assist the client by approving appropriate funding.

To deliver an effective call centre service to achieve member satisfaction.

To reduce the risk associated with hospital and authorized cases.

Answering calls in a way that achieves member satisfaction.

Requirements:

Current registration with the South African Nursing Council (SANC)

Degree/Diploma in Nursing

A minimum of 5 Years practical experience as a nursing practitioner with experience in Trauma, ICU or Theatre

MS Office

Salary: Market related

Please send your CV to

Closing date 26/09/2025

• 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

• 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