Hospital Case Manager

5 days ago

Mbombela, South Africa Medi Clinic Full time

Mediclinic Nelspruit| Sonheuwel, Nelspruit | South Africa Closing date: 05/08/2025 Number of positions: 1Recruiter name: Nhlanhla Samaria Mahlangu Reference number: 60529 Workplace Type:On-sitePermanent 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 MAIN PURPOSE OF JOB 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. KEY RESPONSIBILITY AREAS 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) REQUIRED EDUCATION ESSENTIAL EDUCATION: Clinical qualification DESIRED EDUCATION: Registered Nurse / Professional Nurse or qualified Paramedic REQUIRED EXPERIENCE 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 REQUIRED JOB SKILLS AND KNOWLEDGE 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 #J-18808-Ljbffr

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