4 Child Welfare jobs in Gauteng
Manager : Field Case Management
Johannesburg, Gauteng
Road Accident Fund
Posted 16 days ago
Job Viewed
Job Description
Job title : Manager : Field Case Management
Job Location : Gauteng, Johannesburg Deadline : June 23, 2025 Quick Recommended Links
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Key Performance Areas
Policy and Strategy Review and Implementation
- Provide input into the enhancement and implementation of the case management strategy and plan that ensure alignment with short-term and long-term objectives.
- Keep up to date with effective case management policy and practice execution strategies
Case Management and Administration
- Manage all assigned cases.
- Manage the appointment of caregivers and the provision of the necessary training.
- Ensure that case management programs objectives are met by evaluating the effectiveness of alternative care services and that cost effective, quality care is maintained.
- Present cases at case rounds / conferences to obtain multidisciplinary perpective & recommendations to achieve optimal outcomes.
- Manage the provision of claimants / caregiver care plan and compliance reporting.
- Manage claimants case management plans, authorizations, assessment, and levels of care.
- Manager the review of medical records to identify specific medical issues.
- Manager the development of practice and / or clinical guidelines for cost effective rehabilitation of care.
- Identify financial and business risks to the Fund and escalate accordingly.
Management of Claimant Rehabilitation Care
- Manage claimants progress and outcomes
- Manage and analyse the determination of the claimant needs and coordinate reasonable recommendations for all the necessary and identified modifications in line with the nature of claimant's medical condition.
- Manage an in-home assessments by Senior Officer : Field Case management to assess members overall health needs, which includes medication reconciliation.
- Manage the identification of gaps in care as claimants transition from a care facility back to their home.
- Provide management direction and guidance in ensuring that healthcare services are accounted for by liaising with relevant personnel for authorisations and ensuring compliance with case management procedures, staandards, and protocols.
- Manage the approval and appointment of service providers in line with the defined scope of work.
- Determine the suitable rehabilitation stay for the claimant based on the required level of care and monitor the implementation.
- Ensure that an ongoing support to the family is provided on coping mechanisims post discharge.
- Manage and monitor the rehabilitation plans of the claimant / client for effectiveness.
Integrating of Back to work and Community
- Corporate with the treating physician to obtain full or conditional release to return to work before injury becomes a lost time claim where ot is neccessary.
- Coordinates with the employer to develop a modified duty job for the injured worker who cannot immediately return ro his / her full pre-injury employment where required.
- Ensure succesful integration of the claimant back to the family and educate the claimant and family on the condition of the claimant.
- Identify community resources based on the claimants need.
Manage the Submission of Invoices
- Validate and quality assure invoices submitted to ensure that they are aligned to the services and treatments caimed for.
- Put measures in place to guard against the submission of fraudulent invoices.
- Manage the compliance of invoiced services from service providers and ensure validity in line with RAF Act and guidelines.
- Manage timeous payment of service providers.
Reporting
- Manage the completion of all relevant reports (timesheets, expenses, program specific reports) as per specified timelines and required standards.
- Provide report on all assigned cases, and the monthly rehabilitation reports of the claimants.
- Prepare and submit monthly and quarterly performance case management reports or as and when required to provide progress updates and / or inform management decisions.
- Ensure complete, timely, and accurate reporting with appropriate levels of escalation.
- Provide reports on the possibilities of back to work integration for claimants.
- Reporting on the cost associated with the undertaking certificate against what has been spent on care givers.
Stakeholder Management
- Build productive relationships with healthcare professionals to ensure adequate referral rates to achieve budgeted occupancy level.
- Ensure accurate service knowledge and advice and keep stakeholders informed of products and service options.
- Resolve stakeholder queries and complaints promptly.
- Manage relations with service providers and health professionals to ensure adherence in line with the protocols and service level agreement.
People Management
- Ensure the sourcing, development and retention of high-performance team.
- Manage the recruitment of operational workforce in line with employment equity targets
- Manage staff in the department to ensure that they achieve their objectives in line with strategic objectives of the RAF.
- Manage the implementation of human capital processes and procedures to control / regulate workplace conflict and / or institute corrective measures and consultation processes to address deviations from standards.
- Allocate, direct, motivate and evaluate subordinates to help them achieve their individual goals.
Qualifications
- Bachelor's Degree / Advanced Diploma in Health Sciences or Medical related Degree.
- Postgraduate in Health Sciences or Medical related qualification will be an added advantage.
- Registration with the relevant Health professional body
Experience
- Relevant 6-8 years' experience in Nursing or Case Management environment of which 2 (two) years must have been on a management / supervisory level / area of expertise.
This advertiser has chosen not to accept applicants from your region.
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Case Manager (Hospital Benefit Management)
Pretoria, Gauteng
Capell Creative
Posted 14 days ago
Job Viewed
Job Description
As the leading medical recruitment agency in South Africa, our client has an exciting opportunity for a Case Manager (Hospital Benefit Management) based in Pretoria, South Africa. The Case Manager (Hospital Benefit Management) is to 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.
Responsibilities
- 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
- Qualified Registered Nurse with a valid SANC
- 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 case 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 longstay 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
Location: Pretoria
To apply, please send your updated CV to
Please be advised that you will be contacted by Medipath Healthcare Recruitment within 14 days should we wish to proceed with your application. Similarly, if you are not contacted by Medipath Healthcare Recruitment, please accept your application as unsuccessful. Your CV will automatically be added to our database and we could be contacting you should a suitable position arise. #J-18808-Ljbffr
This advertiser has chosen not to accept applicants from your region.
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Case Manager (Spinal Programme Management)
Pretoria, Gauteng
H2R Africa
Posted today
Job Viewed
Job Description
Career Opportunity: Case Manager Spinal Programme Management
Location: Pretoria (On-site)
Contract Type: Permanent
Salary: Market-related Cost to Company (including medical aid, provident fund, etc.) Based on experience
About our client:
Our client is a trusted and accredited managed healthcare organisation serving clients in the medical scheme industry. They are proud to support one of South Africas fastest-growing medical schemes and are expanding our specialist services to ensure members receive effective, value-driven healthcare. They are now seeking a skilled and compassionate Case Manager to join our dedicated Spinal Programme Management team.
Purpose of the Role
As a Case Manager, you will play a critical role in managing access, clinical appropriateness, and the financial and medical risk associated with spinal healthcare services. These include back and neck pain interventions, spinal surgeries, imaging, and conservative treatment pathways such as physiotherapy. Your role will require you to evaluate, guide, and coordinate care in line with scheme rules, clinical protocols, and funding guidelines.
Minimum Qualifications
- Registered Nurse with valid SANC registration
OR - Clinical Associate with a Bachelor of Clinical Medical Practice (BCMP) and valid HPCSA registration
Key Skills & Competencies
- Strong clinical knowledge of hospital admissions, Length of Stay (LOS), and Level of Care (LOC)
- Excellent understanding of the SA healthcare landscape, coding standards (ICD-10, CPT4), NRPL, PMB legislation, and treatment protocols
- Working knowledge of spinal, neuro-, and orthopaedic surgical environments (advantageous)
- Experience in managed care, case management, or related fields
- Familiarity with value-based care and holistic patient management
- Proficiency in MS Office (especially Excel) and experience with MIP systems (advantageous)
- Exceptional written and verbal communication skills (English required; proficiency in additional national languages is a plus)
- High emotional intelligence, attention to detail, and the ability to handle sensitive or complex cases with empathy
- Strong decision-making, prioritisation, and multi-tasking skills
Key Responsibilities
- Evaluate service requests, surgical quotations, and clinical codes related to spinal conditions
- Coordinate closely with the Medical Advisor and act on guidance received
- Engage with healthcare providers, members, and hospital case managers
- Manage hospitalised patients and facilitate discharge planning and follow-ups
- Perform case reviews and authorisation assessments
- Prepare documentation, clinical reports, and case studies as required
- Ensure accurate and timeous case record keeping and communication with stakeholders
- Continuously monitor and assess treatment efficacy, costs, and member outcomes
- Contribute to improving processes within the Spinal Programme and broader managed healthcare team
Additional Requirements
- Ability to work independently and manage a caseload under pressure
- Willingness to work overtime when needed to meet workflow targets
- High professional integrity and confidentiality in handling patient data
- Internal applicants must consult their Line Manager before applying
This advertiser has chosen not to accept applicants from your region.
2
Case Manager (Spinal Programme Management
Pretoria, Gauteng
H2R Africa
Posted today
Job Viewed
Job Description
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 a new opportunity and position has presented itself in their commitment to ensure that our medical scheme beneficiaries are supported to access healthcare services.
PURPOSE OF THE POSITION:
To actively manage the access, clinical appropriateness and risk (both financial and clinical) of all requests for services pertaining to back and neck pain management, spinal surgery, scans and associated healthcare services in accordance with the relevant scheme rules, clinical protocols and funding guidelines.
To critically consider and propose relevant treatment alternatives that include, but are not limited to, conservative treatment options like physiotherapy.
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.
QUALIFICATIONS:
SKILLS AND COMPTENCIES REQUIRED :
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 a new opportunity and position has presented itself in their commitment to ensure that our medical scheme beneficiaries are supported to access healthcare services.
PURPOSE OF THE POSITION:
To actively manage the access, clinical appropriateness and risk (both financial and clinical) of all requests for services pertaining to back and neck pain management, spinal surgery, scans and associated healthcare services in accordance with the relevant scheme rules, clinical protocols and funding guidelines.
To critically consider and propose relevant treatment alternatives that include, but are not limited to, conservative treatment options like physiotherapy.
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.
QUALIFICATIONS:
- Registered Nurse with valid registration with SANC
- Clinical Associate (Bachelor of Clinical Medical Practice (BCMP)) with valid registration with HPCSA
SKILLS AND COMPTENCIES REQUIRED :
- Thorough, well-grounded clinical knowledge of hospital admissions, LOS and LOC.
- Excellent knowledge of the South African Healthcare industry and prevailing legislation, current coding structures i.e. ICD10s, CPT4, NRPL, PMB conditions and clinical protocols
- Extensive clinical knowledge related to all aspects of holistic patient management.
- Work experience within Orthopaedic and/ or Surgical theatre and wards will be advantageous.
- Solid understanding of value-based care.
- Demonstrated ability to manage a portfolio of active patient cases and to accurately update and maintain patient case information.
- Outcome focused with the ability to manage competing demands
- Establishing and maintaining effective relationships with key stakeholders.
- Excellent telephonic and written communication skills (will be tested)
- Computer literate - MS Office Suite (intermediate) required.
- MIP Application System experience will be advantageous.
- Reporting MS Excel (intermediate) required (will be tested)
This advertiser has chosen not to accept applicants from your region.
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