42 Child Welfare Specialist jobs in South Africa

Position Purpose:

To manage the clinical operations to ensure best clinical practice and success is achieved for members and that Service Level Agreements are met in order for the scheme and organisation to remain sustainable and stable

Experience:

8 years experience including:

Medical industry experience in Renal, Mental Health and Alternative to hospital.

4 years medical industry experience.

4 years management experience in medical industry.

Qualifications:

Registered Nurse with professional membership. Post basic qualification in management.

Accountabilities:

Compliance & Risk Management

• Ensure legal and regulatory compliance is upheld.
• Monitor and address operational risks and governance issues.

Financial Management

• Control expenses and identify cost-saving opportunities to meet financial targets.

Operating Model

• Develop and execute operational plans aligned with delivery goals.
• Improve internal processes and resolve operational conflicts.
• Drive performance against service level agreements and quality standards.
• Provide clinical oversight and manage clinical risks and outcomes.

Strategy Implementation

• Translate departmental business plans into actionable team strategies.
• Implement changes in response to external factors while maintaining best practices.
• Align team plans with Medscheme's strategic direction.

Operational Leadership

• Build and retain high-performing, motivated teams.
• Manage team performance and support staff development.
• Promote diversity and uphold Medscheme values.

Stakeholder Management

• Maintain strong relationships with customers and stakeholders.
• Address stakeholder needs and ensure effective treatment outcomes.
• Respond to queries from bodies like the Council of Medical Schemes and Marketing.

Generic Objectives

Specific Deliverables

Operational Leadership

• Select, retain and grow high performing teams
• Create highly motivated and engaged operating environments

Stakeholder Management

• Ensure stakeholder queries, clinical needs and amendments are implemented to maintain a successful relationship and ensure maximum effectiveness of treatments paid for
• Resolve queries and provide feedback for stakeholders such as the Council of Medical Schemes, Marketing and fund management

Operating Model

• Track and drive team to achieve and maintain defined service level agreements and turnaround times at the defined and approved quality standards
• Evaluate, enhance and implement processes and systems to improve profitability, effectiveness and organisational risk
• Provide clinical management, support and analysis where appropriate
• Analyse, assess and manage clinical outcomes and risks

Knowledge

-Understand and demonstrate agile development life cycles

-Knowledge and application of relevant legislation

Skills

• Ability to manage Clinical and Financial risks effectively
• Communication Skills
• Innovates and Takes Risks
• Task Management
• Executive Business Writing Skills
• Financial Acumen
• Neural Network Architecture
• Change Management
• Ability to evaluate clinical challenges and needs
• Quality Driven
• Computer Technology Skills

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

Should you not receive feedback within a month of applying, please consider your application unsuccessful

?Assessment on all applications for dispute resolution to determine jurisdiction.

?Identification of issues in dispute in terms of Section 39 of the CSOS Act.

?Prepare Notice 43 and 44 in terms of the CSOS Act.

?Facilitate submissions received from various interested parties in terms of Section 44 of the CSOS Act.

?Set the matter down for a Conciliation hearing in terms of Section 47 of the CSOS Act.

?Prepare file for Conciliation hearing.

?Managing and capturing reports on case management system in the division.

?Assist with telephone complaints as well as walk-in applicants.

?Provide weekly feedback to complainants.

?Prepare monthly reports on all matters.

?Maintain diary of all matters.

?Assist with ad hoc administrative support and duties within the division.

?Degree in Law (NQF 7).

?2 ? 3 Years experience in Dispute Resolution processes or the legal environment,

?Knowledge of the Dispute Resolution process and Community Schemes.

?Deadline focused.

?Strong work ethic.

?Team player.

?Knowledge of computerized telephone management system.

?Basic administrative functional knowledge (typing and filing).

Position Purpose:

To lead the team and drive end to end processes in order to deliver a customer-centric business environment. Ensure that the operational area is aligned to Medscheme and client schemes strategic objectives. Provide holistic care that is personalised and accessible, managing the journey end to end. Commit to our service care charter striving to continuously make a positive difference.

Experience:

2 - 3 Years Operational experience and 2 years management experience advantageous

2 years Leadership experience

1 year Experience in Quality Assurance, Workforce Planning and Recruitment

Qualifications:

Diploma in General Nursing and a Degree/Diploma in ICU

Compliance and Risk Management

• Defined legal, statutory and regulatory compliance is appropriately implemented and maintained at the required standards for the team

• Implemented team operational risk and governance structures, measures and frameworks are monitored and necessary action is taken to address issues, when necessary

Financial Management

• Manage expenses and costs and identify cost saving opportunities to support the department in achieving its financial goals and targets

Operating Model

• Implement team operational plans and manage that the defined delivery objectives are met through supporting, and being supported by other teams within and linked to the department / project

• Identify opportunities to improve the team's core operational internal processes and internal supply chain

• Resolve team operational conflicts

• Ensure delivery targets/objectives are met and motivate the team to operate in a mutually supportive manner to achieve successful delivery

Operational Implementation of Strategy

• Plan and implement daily, weekly and/or quarterly operational changes within the team to respond to important external influences

• Ensure relevant sections of the business plan are implemented in a manner that supports operational quality and meets the defined departmental priorities

• Communicate the relevant sections of the team operational plan to facilitate buy-in of the employees

• Ensure implementation of workplans in a way that maintains operational best practice and leads to continuous delivery improvement

Operational Leadership

• Manage the operational performance of the team as per HR frameworks and policies to ensure delivery to agreed standards and objectives

• Provide appropriate staff development, coaching and mentoring and retain skilled and engaged employees within the team and Medscheme

• Support transformation through valuing diversity within the team and department

• Behave in alignment with the Medscheme values

Stakeholder Management

-We are looking for a dynamic and results-driven leader to join our team, someone who can drive operational excellence, stakeholder engagement, and strategic delivery. The ideal candidate will ensure legal, statutory, and regulatory compliance is upheld, while implementing effective risk and governance frameworks. You will manage departmental expenses, identify cost-saving opportunities, and support financial targets. This role requires strong operational leadership, including the implementation of team plans, resolution of conflicts, and continuous improvement of internal processes. You will lead daily, weekly, and quarterly operational changes aligned with business priorities, ensuring best practices and consistent delivery. A key part of the role involves managing team performance, coaching and mentoring staff, fostering diversity, and creating a safe, engaging work environment. You will build and maintain strong relationships with internal and external stakeholders, address concerns professionally, and collaborate across departments to ensure timely resolutions. Additional responsibilities include onboarding new employees, maintaining quality standards, supporting ISO and compliance requirements, conducting performance reviews, and representing business capabilities in governance forums. You will also oversee resource planning, manage service levels, monitor trends, and drive customer satisfaction. Embracing digital transformation and agile methodologies is essential, as is the ability to adapt to changing business needs and ensure continuity during unplanned downtime. If you are passionate about leading teams, driving strategic outcomes, and making a meaningful impact, we invite you to apply.

Generic Objectives

People Leadership:

-Lead and inspire your people and drive team collaboration.

-Develop and support your people growth by focusing on their strengths

and styles.

-Coach and enable team to maximise their potential.

-Empower your people with skills to improve confidence, knowledge and communication

skills.

-Amplify your people's imagination and self

-learning.

-Create a safe and happy working environment that inspires all, adapting to needs of

your people.

-Manage, monitor leave and wellness of your people.

-Recognise and appreciate excellence and team collaboration in real

-time.

Continuous improvement:

-Identify areas of improvement and solving for sustainable solutions through root cause analysis, lean six sigma methodologies

and feedback loops.

-Assist with user acceptance testing and coach your teams through changes.

-Demonstrate excellence in communication and daily

performance management.

Workforce Management:

-Perform Resource planning, forecasting and management across all channels and touch points.

-Manage and plan downtime when required.

-Manage work volume and ensure service levels are met and improved.

Business Continuity Management:

-Understand how to manage business continuity and unplanned downtime.

-Manage incidents and service level

continuity.

Manage and Maintain Operational Content:

-Represent the business capability in the organisation's governance model.

-Collaborate with solution

capabilities and product owners to ensure operational content enables the implementation of all business strategies.

-Manage and maintain consistency

of all Standard Operating Processes and Operational Resources by working collaboratively with capability owners and forums.

-Attend and participate

in all required forums in the governance model, supporting all roles in the business model.

Manage Performance:

-Motivate the team to achieve the organisational goals.

-Manage timelines and priorities to ensure business goals are met.

-Conduct performance reviews and align to frequent coaching.

-Provide exceptional organisation and focus for the team. Conduct performance management.

Recruitment Management:

-Manage and adhere to all recruitment policies and processes.

-Empower and enable new employees ensuring all resources are

ready to ensure a seamless and engaging on boarding.

Relationship Management:

-Collaborate and manage all stakeholders proactively.

-Understand your stakeholders needs.

-Build and establish relationships

at all levels with external partners and internal departments so ensure that timeous resolutions are found to any problems that may arise.

-Develop, maintain and improve consistent client communication and engagements. Be a brand ambassador.

Perception Management:

-Support the business objectives and drive customer satisfaction through the required metrics.

-Monitor trends and provide

possible improvements. Lead the delivery of excellence in customer satisfaction.

Quality Management:

-Manage the implementation of the Quality Management Framework with adherence to standards.

-Empower and drive the ISO and compliance requirements set by the business, monitor and improve.

-Perform quality evaluations for team members and peer to peer

reviews. Understand and drive digital transformation:

-Understand and embrace technology and attributes required in a Digital Environment.

-Empower

the digital agile way of working to optimise efficiencies, improve communication and collaboration.

Knowledge

-Health Care Industry

-Knowledge and application of relevant legislation and regulations

-Knowledge, application and improvement of policies and procedures

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

Should you not receive feedback within a month of applying, please consider your application unsuccessful

Division: 3300

Reference No: 6037

Location:

Johannesburg, Gauteng, ZA

Employment Type: Permanent

Disability (EE targeted role): No

T.A.S.K Grade: 12

Job Posting Salary: R579,259.00

Job Posting End Date: 30 Sep 2025

The Road Accident Fund's mission is to provide appropriate cover to all road users within the borders of South Africa; to rehabilitate and compensate persons injured as a result of motor vehicle accidents in a timely and caring manner; and to actively promote safe use of our roads.
Purpose of the job:
The
Senior Officer: Hospital
Case Management
is accountable for the coordination of medical care for motor vehicle accident patients/claimants in Hospitals.

Key Performance Areas
Assessment Of Injuries

• Assess extent of injuries on admitted patients.
• Daily assessment of patient according to prescribed measurements.
• Conduct daily patient scoring and data collecting.
• Monitor quality of care.
• Select and monitor clinical pathways.
• Identify patients' needs.
• Identify and record pre-existing conditions.

Facilitate Patient Care

• Facilitate multi-disciplinary patient care where appropriate.
• Facilitate timely transfers into the appropriate levels of care.
• Coordinate the admission and pre authorisations of the transfers.
• Coordinate and provide neccessary health education.
• Discharge planning and vocational guidance for the afterlife changing event for client.
• Drug utilization review.
• Proper handover to Field Case Management for continuation of care.

Patient Advocacy

• Cost Benefits analysis of the medical services.
• Liason between patient and care team to ensure common understanding and conflict resolution.
• Negotiate and procure resource services from providers.
• Ensure that patient confidentiality is maintained by all parties.

Facilitate the Accuracy and Effective Submission of Invoices

• Ensure that accounts submitted to the fund from service providers are valid in terms of RAF guidelines and the Road Accident Fund Act.
• Assess and monitor claims invoices to curb over servicing or abuse and fraudulent claims.
• Ensure that the accounts are paid timeously, according to service level agreements.
• Ensure that services and treatments claimed for are accident related (related to the accident under consideration).
• Compare outcomes and cost of different therapeutic modalities and surgical techniques and the information provided is invaluable in developing guidelines for clinical management.

Reporting

• Compile and update Hospital Case Management reports.
• Recommend issuing of Undertaking Certificate.
• Provide a reasonableness report of patient care in preparation of the rehabilitation post discharge.

Stakeholder Management

• Communicate with all levels of stakeholders.
• Participate in relevant external RAF activities and events
• Ongoing engagements with service providers.

Qualifications

• Bachelor's Degree/ Advanced Diploma in Nursing/ Allied Health Professions or related qualification
• Registration with the relevant Health Professional Council body

Experience

• Relevant 4 years' experience in the Medical environment.
• Experience in Managed Healthcare.
• Knowledge of ICD and CPT coding will be an advantage.
• Valid code 08 driving license.

Competencies

• Behavioural

• Planning, Organising and Coordinating

• Personal Mastery
• Emotional wisdom and decision making
• Ethics and Values

• Client Service Orientation

• Technical

• Core specialities in the case management process.

• Knowledge of healthcare operations.
• Ability to maintain patient confidentiality.
• Full knowledge of medical tariffs, treatment plans.
• Coding standards and protocols.
• Knowledge of PFMA to be able to analyse different requirements as per the claimants.

NB: "RAF offers Total Employment Cost packages with no additional contributions from the Employer, successful candidates are required to structure their packages in a manner that will suit their needs."
The Road Accident Fund subscribes to the principles of employment equity and preference will be given to People with Disabilities.
Applicants who have not received any correspondence from us within six weeks from the closing date can consider themselves unsuccessful
Security Vetting shall be conducted on all prospective employees
It is the applicants' responsibility to have foreign qualification evaluated by the South African Qualification Authority (SAQA) and to provide proof of such evaluation.

Division: 3300

Reference No: 6080

Location:

East London, Eastern Cape, ZA

Employment Type: Permanent

Disability (EE targeted role): No

T.A.S.K Grade: 12

Job Posting Salary: R579,259.00

Job Posting End Date: 26 Sep 2025

The Road Accident Fund's mission is to provide appropriate cover to all road users within the borders of South Africa; to rehabilitate and compensate persons injured as a result of motor vehicle accidents in a timely and caring manner; and to actively promote safe use of our roads.
SENIOR OFFICER: HOSPITAL CASE MANAGEMENT (X3) – TASK GRADE 12

Locations:

• East London (2 positions)
• Mthatha (1 position)

Purpose of the job: The Senior Officer: Hospital Case Management is responsible for the coordination of medical care for motor vehicle accident patients/claimants in Hospitals.

Key Performance Areas

Assessment of Injuries

• Assess extent of injuries on admitted patients.
• Daily assessment of patient according to prescribed measurements.
• Conduct daily patient scoring and data collecting.
• Monitor quality of care.
• Select and monitor clinical pathways.
• Identify patients' needs.
• Identify and record pre-existing conditions.

Facilitate patient care

• Facilitate multi-disciplinary patient care where appropriate.
• Facilitate timely transfers into the appropriate levels of care.
• Coordinate the admission and pre authorisations of the transfers.
• Coordinate and provide necessary health education.
• Discharge planning and vocational guidance for the afterlife changing event for client
• Drug utilization review.
• Proper handover to Field Case Management for continuation of care.

Patient advocacy

• Cost Benefits analysis of the medical services.
• Liaison between patient and care team to ensure common understanding and conflict resolution.
• Negotiate and procure resource services from providers.
• Ensure that patient confidentiality is maintained by all parties.

Facilitate the accuracy and effective submission of invoices

• Ensure that accounts submitted to the fund from service providers are valid in terms of RAF guidelines and the Road Accident Fund Act.
• Assess and monitor claims invoices to curb over servicing or abuse and fraudulent claims.
• Ensure that the accounts are paid timeously, according to service level agreements.
• Ensure that services and treatments claimed for are accident related (related to the accident under consideration).
• Compare outcomes and cost of different therapeutic modalities and surgical techniques and the information provided is invaluable in developing guidelines for clinical management.

Reporting

• Compile and update Hospital Case management reports.
• Recommend issuing of Undertaking Certificate.
• Provide a reasonableness report of patient care in preparation of the rehabilitation post discharge.

Stakeholder management

• Communicate with all levels of stakeholders.
• Participate in relevant external RAF activities and events.
• Ongoing engagements with service providers.

Qualifications

• Bachelor's Degree or Advanced Diploma in Nursing/ Allied Health Professions or related qualification.
• Registration with the relevant Health Professional Council Body.

Experience

• Relevant 4 years' experience in the medical environment.
• Experience in Managed Healthcare.
• Knowledge of ICD and CPT coding will be an advantage.
• Valid code 8 driving license.

Technical and behavioural competencies required

Behavioural

• Planning Organising and Coordinating.
• Personal Mastery.
• Judgment and Decision Making.
• Ethics and Values.
• Client Service Orientation.

Technical

• Core specialities in the case management process.
• Knowledge of healthcare operations.
• Ability to maintain patient confidentiality.
• Full knowledge of medical tariffs, treatment plans.
• Coding standards and protocols.
• Knowledge of PFMA to be able to analyse different requirements as per the claimants.

NB: "RAF offers Total Employment Cost packages with no additional contributions from the Employer; successful candidates are required to structure their packages in a manner that will suit their needs."
The Road Accident Fund subscribes to the principles of employment equity and preference will be given to People with Disabilities.
Applicants who have not received any correspondence from us within six weeks from the closing date can consider themselves unsuccessful
Security Vetting shall be conducted on all prospective employees
It is the applicants' responsibility to have foreign qualification evaluated by the South African Qualification Authority (SAQA) and to provide proof of such evaluation.

Division: 3300

Reference No: 5998

Location:

Bellville, Western Cape, ZA

Employment Type: Permanent

Disability (EE targeted role): No

T.A.S.K Grade: 12

Job Posting Salary: R579,259.00

Job Posting End Date: 23 Sep 2025

The Road Accident Fund's mission is to provide appropriate cover to all road users within the borders of South Africa; to rehabilitate and compensate persons injured as a result of motor vehicle accidents in a timely and caring manner; and to actively promote safe use of our roads.
Purpose of the job: The Senior Officer: Hospital Case Management is responsible for the coordination of medical care for motor vehicle accident patients/claimants in Hospitals.

Key Performance Areas

Assessment of Injuries

• Assess extent of injuries on admitted patients.
• Daily assessment of patient according to prescribed measurements.
• Conduct daily patient scoring and data collecting.
• Monitor quality of care.
• Select and monitor clinical pathways.
• Identify patients' needs.
• Identify and record pre-existing conditions.

Facilitate patient care

• Facilitate multi-disciplinary patient care where appropriate.
• Facilitate timely transfers into the appropriate levels of care.
• Coordinate the admission and pre authorisations of the transfers.
• Coordinate and provide necessary health education.
• Discharge planning and vocational guidance for the afterlife changing event for client
• Drug utilization review.
• Proper handover to Field Case Management for continuation of care.

Patient advocacy

• Cost Benefits analysis of the medical services.
• Liaison between patient and care team to ensure common understanding and conflict resolution.
• Negotiate and procure resource services from providers.
• Ensure that patient confidentiality is maintained by all parties.

Facilitate the accuracy and effective submission of invoices

• Ensure that accounts submitted to the fund from service providers are valid in terms of RAF guidelines and the Road Accident Fund Act.
• Assess and monitor claims invoices to curb over servicing or abuse and fraudulent claims.
• Ensure that the accounts are paid timeously, according to service level agreements.
• Ensure that services and treatments claimed for are accident related (related to the accident under consideration).
• Compare outcomes and cost of different therapeutic modalities and surgical techniques and the information provided is invaluable in developing guidelines for clinical management.

Reporting

• Compile and update Hospital Case management reports.
• Recommend issuing of Undertaking Certificate.
• Provide a reasonableness report of patient care in preparation of the rehabilitation post discharge.

Stakeholder management

• Communicate with all levels of stakeholders.
• Participate in relevant external RAF activities and events.
• Ongoing engagements with service providers.

Qualifications

• Bachelor's Degree or Advanced Diploma in Nursing/ Allied Health Professions or related qualification.

• Registration with the relevant Health Professional Council body.

Experience

• Relevant 4 years' experience in the medical environment.
• Experience in Managed Healthcare.
• Knowledge of ICD and CPT coding will be an advantage.
• Valid code 8 driving license.

Technical and behavioural competencies required

Behavioural

• Planning Organising and Coordinating.
• Personal Mastery.
• Judgment and Decision Making.
• Ethics and Values.
• Client Service Orientation.

Technical

• Core specialities in the case management process.
• Knowledge of healthcare operations.
• Ability to maintain patient confidentiality.
• Full knowledge of medical tariffs, treatment plans.
• Coding standards and protocols.
• Knowledge of PFMA to be able to analyse different requirements as per the claimants.

NB: "RAF offers Total Employment Cost packages with no additional contributions from the Employer; successful candidates are required to structure their packages in a manner that will suit their needs."
The Road Accident Fund subscribes to the principles of employment equity and preference will be given to People with Disabilities.
Applicants who have not received any correspondence from us within six weeks from the closing date can consider themselves unsuccessful
Security Vetting shall be conducted on all prospective employees
It is the applicants' responsibility to have foreign qualification evaluated by the South African Qualification Authority (SAQA) and to provide proof of such evaluation.

We are seeking an assertive, highly organized Team Leader to guide a case management team in the healthcare and insurance sector. This role requires someone who is both a strong people manager and a disciplined, results-driven leader someone who ensures cases move forward with precision, urgency, and accountability.

Beyond process oversight, this leader must be able to think critically, apply judgment in complex situations, and actively develop the team through training and coaching.

• Lead, mentor, and evaluate a team of case managers and support staff.
• Drive accountability, ensuring every case is handled accurately, on time, and to the highest standard.
• Act as the primary escalation point for clients, clinics, and insurance providers.
• Design and deliver training to upskill team members and ensure consistent standards.
• Use strategic judgment to resolve issues quickly and effectively, even when clear procedures dont exist.
• Set clear expectations, monitor performance, and provide coaching for continuous improvement.
• Streamline workflows to increase efficiency and client satisfaction.
• Represent the team in client meetings and management reviews with confidence and professionalism.

• 5+ years experience in healthcare administration, insurance verification, or case management.
• 2+ years in a leadership, supervisory, or operations role.
• Proven experience training, coaching, and developing staff.
• Strong knowledge of case management processes, insurance workflows, and compliance requirements.
• Demonstrated success in problem-solving and decision-making under pressure.
• Excellent communication skills, with the ability to influence and guide both clients and staff.

• Proactive, disciplined, and detail-oriented, with a nothing slips through the cracks mindset.
• Thinks strategically, trains effectively, and develops others to reach higher performance levels.
• Confident holding others accountable while motivating them to excel.
• Thrives under pressure and maintains a structured, solution-focused approach in all situations.

Division: 3300

Reference No: 6038

Location:

Johannesburg, Gauteng, ZA

Employment Type: Permanent

Disability (EE targeted role): No

T.A.S.K Grade: 12

Job Posting Salary: R579,259.00

Job Posting End Date: 21 Oct 2025

The Road Accident Fund's mission is to provide appropriate cover to all road users within the borders of South Africa; to rehabilitate and compensate persons injured as a result of motor vehicle accidents in a timely and caring manner; and to actively promote safe use of our roads.
Purpose of the job:
The
Senior Officer: Hospital
Case Management
is accountable for the coordination of medical care for motor vehicle accident patients/claimants in Hospitals.

Key Performance Areas
Assessment Of Injuries

• Assess extent of injuries on admitted patients.
• Daily assessment of patient according to prescribed measurements.
• Conduct daily patient scoring and data collecting.
• Monitor quality of care.
• Select and monitor clinical pathways.
• Identify patients' needs.
• Identify and record pre-existing conditions.

Facilitate Patient Care

• Facilitate multi-disciplinary patient care where appropriate.
• Facilitate timely transfers into the appropriate levels of care.
• Coordinate the admission and pre authorisations of the transfers.
• Coordinate and provide neccessary health education.
• Discharge planning and vocational guidance for the afterlife changing event for client.
• Drug utilization review.
• Proper handover to Field Case Management for continuation of care.

Patient Advocacy

• Cost Benefits analysis of the medical services.
• Liason between patient and care team to ensure common understanding and conflict resolution.
• Negotiate and procure resource services from providers.
• Ensure that patient confidentiality is maintained by all parties.

Facilitate the Accuracy and Effective Submission of Invoices

• Ensure that accounts submitted to the fund from service providers are valid in terms of RAF guidelines and the Road Accident Fund Act.
• Assess and monitor claims invoices to curb over servicing or abuse and fraudulent claims.
• Ensure that the accounts are paid timeously, according to service level agreements.
• Ensure that services and treatments claimed for are accident related (related to the accident under consideration).
• Compare outcomes and cost of different therapeutic modalities and surgical techniques and the information provided is invaluable in developing guidelines for clinical management.

Reporting

• Compile and update Hospital Case Management reports.
• Recommend issuing of Undertaking Certificate.
• Provide a reasonableness report of patient care in preparation of the rehabilitation post discharge.

Stakeholder Management

• Communicate with all levels of stakeholders.
• Participate in relevant external RAF activities and events
• Ongoing engagements with service providers.

Qualifications

• Bachelor's Degree/ Advanced Diploma in Nursing/ Allied Health Professions or related qualification
• Registration with the relevant Health Professional Council body

Experience

• Relevant 4 years' experience in the Medical environment.
• Experience in Managed Healthcare.
• Knowledge of ICD and CPT coding will be an advantage.
• Valid code 08 driving license.

Competencies

• Behavioural

• Planning, Organising and Coordinating

• Personal Mastery
• Emotional wisdom and decision making
• Ethics and Values

• Client Service Orientation

• Technical

• Core specialities in the case management process.

• Knowledge of healthcare operations.
• Ability to maintain patient confidentiality.
• Full knowledge of medical tariffs, treatment plans.
• Coding standards and protocols.
• Knowledge of PFMA to be able to analyse different requirements as per the claimants.

NB: "RAF offers Total Employment Cost packages with no additional contributions from the Employer, successful candidates are required to structure their packages in a manner that will suit their needs."
The Road Accident Fund subscribes to the principles of employment equity and preference will be given to People with Disabilities.
Applicants who have not received any correspondence from us within six weeks from the closing date can consider themselves unsuccessful
Security Vetting shall be conducted on all prospective employees
It is the applicants' responsibility to have foreign qualification evaluated by the South African Qualification Authority (SAQA) and to provide proof of such evaluation.

Division: 3300

Reference No: 6149

Location:

Witbank, Mpumalanga, ZA

Employment Type: Permanent

Disability (EE targeted role): No

T.A.S.K Grade: 12

Job Posting Salary: R579,259.00

Job Posting End Date: 26 Sep 2025

The Road Accident Fund's mission is to provide appropriate cover to all road users within the borders of South Africa; to rehabilitate and compensate persons injured as a result of motor vehicle accidents in a timely and caring manner; and to actively promote safe use of our roads.
Purpose of the job:
The Senior Officer: Hospital Case Management is responsible for the coordination of medical care for motor vehicle accident patients/claimants in Hospitals.

Key Performance Areas
Assessment of Injuries

• Assess extent of injuries on admitted patients.
• Daily assessment of patient according to prescribed measurements.
• Conduct daily patient scoring and data collecting.
• Monitor quality of care.
• Select and monitor clinical pathways.
• Identify patients' needs.
• Identify and record pre-existing conditions.

Facilitate patient care

• Facilitate multi-disciplinary patient care where appropriate.
• Facilitate timely transfers into the appropriate levels of care.
• Coordinate the admission and pre authorisations of the transfers.
• Coordinate and provide necessary health education.
• Discharge planning and vocational guidance for the afterlife changing event for client
• Drug utilization review.
• Proper handover to Field Case Management for continuation of care.

Patient Advocacy

• Cost Benefits analysis of the medical services.
• Liaison between patient and care team to ensure common understanding and conflict resolution.
• Negotiate and procure resource services from providers.
• Ensure that patient confidentiality is maintained by all parties.

Facilitate the accuracy and effective submission of invoices

• Ensure that accounts submitted to the fund from service providers are valid in terms of RAF guidelines and the Road Accident Fund Act.
• Assess and monitor claims invoices to curb over servicing or abuse and fraudulent claims.
• Ensure that the accounts are paid timeously, according to service level agreements.
• Ensure that services and treatments claimed for are accident related (related to the accident under consideration).
• Compare outcomes and cost of different therapeutic modalities and surgical techniques and the information provided is invaluable in developing guidelines for clinical management.

Reporting

• Compile and update Hospital Case management reports.
• Recommend issuing of Undertaking Certificate.
• Provide a reasonableness report of patient care in prepation of the rehabilitation post discharge.

Stakeholder Management

• Communicate with all levels of stakeholders.
• Participate in relevant external RAF activities and events.
• Ongoing engagements with service providers.

The Road Accident Fund subscribes to the principles of employment equity and preference will be given to People with Disabilities.
Applicants who have not received any correspondence from us within six weeks from the closing date can consider themselves unsuccessful
Security Vetting shall be conducted on all prospective employees
It is the applicants' responsibility to have foreign qualification evaluated by the South African Qualification Authority (SAQA) and to provide proof of such evaluation.