36 Medical Case Management jobs in South Africa

Patient Care Manager - Registered Nurse


What You Must Have:

• Current State Registered Nurse License
• Current State Driver’s License, reliable transportation, and provide ongoing valid and current auto liability insurance
• Two years of experience as a Hospice Registered Nurse in a clinical care setting, or home health
• Must be highly motivated, self-directed, flexible, and able to work well and participate in a multidisciplinary group setting
• Possess good organization, people and problem solving skills and the ability to multi-task many projects and strategies simultaneously
• Strong critical thinking, organizational, interpersonal, and communication skills

• Competitive Pay
• Medical, Dental & Vision insurance
• Paid Time Off
• Paid holidays
• 401k with up to 4% employer matching
• Tuition reimbursement
• Company car for qualifying individuals
• Mileage reimbursement

• Direct and coordinate clinical departments and sites; assumes responsibility for continuity, quality, and safety of services delivered in compliance with State and federal regulations (Conditions of Participation).

• Supervise and provide direction to nursing staff and team members, in an effort to ensure quality, compliance with Plan of Care, assessment and reassessment of patient's needs and continuity of services by appropriate health care personnel.
• Supports employee and patient education to enhance knowledge, skills and achieve quality experiences. Continuously trains nursing staff to retain employees with the highest quality of patient care.

• Provide coaching, development, feedback and annual evaluations to team members in a professional and timely manner.
• Performance of other duties as required
• Ensure overall compliance with local, state and federal laws, Medicare regulations, and established personnel policies and procedures

Working with Heart to Heart Hospice

We are looking for a compassionate, talented and experienced Patient Care Manager that is experienced in customer service and eager to join an exciting organization.

You can Make A Difference in the lives of others!

At Heart to Heart Hospice, our employees enhance the lives of patients with life-limiting illnesses and their loved ones during a time when compassionate care is needed most. We are dedicated to making a difference in the lives of our patients and their families, and we offer individuals the opportunity to be associated with a caring staff and organization, while creating positive contributions in their community.

It is this Agency's policy to provide equal employment opportunities without regard to age, race, color, religion, military status, gender preference, sex, marital status, national origin or disability.
indeed123

This is a management position
This is a full time position

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Attachments * Attach your Resume Attach Paste Attach a Cover letter AttachOther Information * Do you have an active RN license in the state you will work? Yes No * Do you have 2 years previous experience as a Hospice Registered Nurse? Yes No * Were you referred by someone with Heart to Heart Hospice? If yes, please provide name: If no, please select from below list on how you heard about the position * Desired Salary?

The Case Manager is responsible for answering inbound or internally transferred calls, assessing the caller's needs, taking ownership of the issue, and coordinating an appropriate solution using internal or external resources.

Qualifications

Experience

• Minimum of 2 years’ experience in a call centre environment.
• Minimum of 1 year experience in Roadside Assistance.

Operational Responsibilities

• Ensure timely and professional response to all incoming calls as per client protocols and contractual agreements.
• Analyze assistance requests and determine necessary actions.
• Validate client records and log all relevant details accurately.
• Explain benefits and limits to clients and coordinate solutions.
• Manage case communications and escalate issues as needed.

Dispatch Responsibilities

• Acknowledge case receipt and appoint appropriate service providers within contractual timeframes.
• Verify rates, costs, and mileage, and ensure accurate system entries.
• Coordinate with service providers and inform clients of appointment details.

Follow-up Responsibilities

• Follow up within 20 minutes to confirm contact from service providers.
• Reassign cases if issues arise and update system notes.
• Complete and close cases upon resolution.

Core Competencies

• Strong written communication and fact management skills.
• Effective task management and prioritization.
• Proactive and energetic approach to tasks.
• Ambitious with a focus on achieving results.
• Calm under pressure and good conflict resolution skills.
• Team-oriented with positive attitude and adherence to procedures.

Job Details

• Category: Customer Service
• Type: Full Time
• Location: Johannesburg

Applicants are required to fill out the application form including details such as experience, qualifications, personal information, and upload their CV. By submitting, you agree to data handling policies.

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.

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

• 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

Mediclinic Nelspruit| Sonheuwel, Nelspruit | South Africa

Closing date: 05/08/2025
Number of positions: 1
Recruiter name: Nhlanhla Samaria Mahlangu
Reference number: 60529
Workplace Type:On-site
Permanent

Please note if you are an internal employee on a fixed term contract please apply using an external candidate profile and not your employee profile

To coordinate the hospital case management process and facilitate the communication process between all role players by providing accurate and timeous clinical information to minimise the financial risk for the organisation.

Minimise financial risk by effectively managing patient stay

Ensure compliance to case management procedures, contracts and legal aspects by utilising available resources and systems

Ensure correct and timeous finalisation of cases to facilitate reimbursements from funders of claims

Consistently and timeously communicate with Funders as contractually agreed through the relevant case management channels

Ensure clinical coding standards are adhered to as per Level 3 coding guideline

Lead and manage the people in the Case Management team (if applicable)

ESSENTIAL EDUCATION: Clinical qualification

DESIRED EDUCATION: Registered Nurse / Professional Nurse or qualified Paramedic

ESSENTIAL MINIMUM EXPERIENCE: Minimum of 3 years in a clinical role

DESIRED EXPERIENCE: Experience in Theatre and or ICU; Medical aid background; Experience in private healthcare environment or experience as an ILS/ALS Paramedic

• Anatomy; physiology and terminology
• Funder Contracts; Medical aid requirements/narrations
• Scientific nursing principles and process
• B2B EMS (electronic message system: check status of authorisations and use for trouble,shooting)
• Computer literate (Microsoft Office)
• Authorisation and motivation of Level of Care; Length of Stay; Short Payments etc.
• Relevant aspects of applicable statutory acts (e.g. Consumer Protection Act; PMB; etc.)
• Patient Administration policies and procedures (e.g. Patient Confidentiality; Visitation of external case managers; etc.)
• Daily workflow; managing deviances; coding; and case management processes
• Application of clinical codes and finalisation thereof (Level 3 coding)
• Patient admin programmes on the AS400 system

All applicants will be considered, with the understanding that preference will be given in accordance with the Employment Equity Plan of Mediclinic Southern Africa, as well as internal applicants/employees that meet the minimum requirements.

Please note if you are an internal employee on a fixed term contract please apply using an external candidate profile and not your employee profile

Choose how often (in days) you want to receive a notification:

Closing date: 31/08/2025
Number of positions: 1
Recruiter name: Liezel Alberts
Reference number: 62955
Workplace Type:On-site
Permanent

Please note if you are an internal employee on a fixed term contract please apply using an external candidate profile and not your employee profile

To coordinate the hospital case management process and facilitate the communication process between all role players by providing accurate and timeous clinical information to minimise the financial risk for the organisation

Minimise financial risk by effectively managing patient stay

Ensure compliance to case management procedures, contracts and legal aspects by utilising available resources and systems

Ensure correct and timeous finalisation of cases to facilitate reimbursements from funders of claims

Consistently and timeously communicate with Funders as contractually agreed through the relevant case management channels

Ensure clinical coding standards are adhered to as per Level 3 coding guideline

Lead and manage the people in the Case Management team (if applicable)

DESIRED EDUCATION: Registered Nurse / Professional Nurse or qualified Paramedic

ESSENTIAL MINIMUM EXPERIENCE: Minimum of 3 years in a clinical role

DESIRED EXPERIENCE: Experience in Theatre and or ICU; Medical aid background; Experience in private healthcare environment or experience as an ILS/ALS Paramedic

• Understanding of anatomy; physiology and medical terminology
• Funder Contracts; Medical aid requirements/narrations
• Scientific nursing principles and process
• Authorisation and motivation of Level of Care; Length of Stay; Clinical Coding, high-cost stock, Short Payments etc.
• Use of electronic systems (i.e. B2B or Funder portals) for the purposes of requesting authorisations, performing case management updates and for troubleshooting)
• Relevant aspects of applicable statutory acts (e.g. Consumer Protection Act; PMB; etc.)
• Patient Administration policies and procedures (e.g. Patient Confidentiality; Visitation of external case managers; etc.)
• Daily workflow; managing deviances; clinical coding; and case management processes
• Application of clinical codes and finalisation thereof

All applicants will be considered, with the understanding that preference will be given in accordance with the Employment Equity Plan of Mediclinic Southern Africa, as well as internal applicants/employees that meet the minimum requirements.

Please note if you are an internal employee on a fixed term contract please apply using an external candidate profile and not your employee profile

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