Case Manager Healthcare Medical

2 weeks ago

Johannesburg, South Africa Complement Recruitment Full time

**Case Management Lead - Johannesburg Gauteng**

**Salary: Market Related**

**Purpose of Position**:
Complement Recruitment are recruiting for a Case Management Lead for a permanent position based in Sandton, Johannesburg, Gauteng. Our client is looking for an experienced, commercially minded and operationally strong case management lead with a proven track record of implementing and streamlining projects and making sure they have high impact for the business and the care of our Consumers (Patients). Ideally someone sees a discrepancy or concern and takes the initiative and responsibility to immediately raise it and be able to come up with proposed actions. As Case Management Lead, you would form an integral part of the journey by facilitating the reimbursement process and using the available resources to promote Consumer quality of care, and the best possible funding outcomes.

**Minimum Requirements**:

- High school diploma or equivalent required;
- Minimum Education of Bachelor’s Degree;
- Minimum 2 years’ experience in a medical / healthcare; funding or managed care related environment.
- Relevant experience in case management with a key understanding of the funder landscape within South Africa is crucial.
- 2 years team lead experience is advantageous

Knowledge, Skills And Abilities
- Thorough knowledge of case management principles, healthcare management and ICD coding knowledge;
- A comprehensive understanding of the Medical Schemes Act and regulations;
- Set knowledge and expertise when it comes to PMB (Prescribed Minimum Benefit) conditions and PMB level of Care;
- Strong business acumen and commercial understanding;
- Strong written and verbal communication skills; reporting skills;
- A deep passion for customer service and an understanding of customer behaviour;
- Ability to convey medical terms and treatment plans so they are understood by Consumers;
- Excellent organisational and time management skills;
- Astute problem-solving skills with the ability to multi-task;
- Compassionate and empathetic demeanour for Consumers with the ability to work both independently and in a group/team environment;
- Excellent numerical skills and the ability to construct fact-based recommendations and business cases

Personal Attributes
- Strong passion for making life easier for people with intimate healthcare needs;
- Strong alignment with Company Vision, Mission and values;
- Quick learner, intellectual capacity with a high degree of common sense, resourcefulness, and flexibility;
- Organized and highly structured with the ability to successfully lead multiple projects and manage deadlines as well as handle ambiguity;
- Should have excellent communication and decision-making skills, as well as experience working closely with people;
- Ability to balance needed attention to detail with a pragmatic view on opportunity, impact and feasibility;
- Growth mind-set;
- Strong communication skills face to face and over the phone and ability to interact with different cultures in South Africa

**Duties**:
Consumer Advocacy
- Work cross-functionally to ensure smooth end-to-end authorization for Portfolio Consumers that delivers an optimal experience;
- Create and maintain a clear set of guidelines that educates Consumers on their condition, their funding options and their Medical Scheme benefit limit and rules.
- Help Consumers navigate our local health reimbursement system and own their relationship with the Medical Schemes by connecting them with the correct departments within medical schemes.
- Provide guidance on early case strategy and the appropriate pathway for future management i.e., settlement or investigation.

Relationship building with internal and external stakeholders
- Own and create the relationship with Medical Aid Schemes in South Africa together with Market Access to ensure close collaboration for improved patient outcomes.
- Acting as a technical expert for the team, by reviewing and dealing with complex, challenging and sensitive case management issues when it comes to Consumers’ needs.

People Leadership
- Live our leadership principles and proactively manage the team of Case Management Specialists and their KPIs
- Coaching and training of the team and ensuring new processes are implemented effectively

Reporting and Tracking
- Lead the case management processes by using a continuous improvement mindset (identify need for change, plan, implement and test).
- Implement Case Management controls for tracking and feedback to our Consumers and our internal team.
- Agree to clear KPI’s, and drive performance management against those KPIs.

Forward Thinking And Innovation
- Monitoring and gaining an understanding of the evolution of medical aid plans and collaborating with key stakeholders in the financial management of treatments;
- Mitigation of risks related to health spend.
- Review Treatment plans on a case by case basis, within the bounds of protocols and guidelines;
**Find Us on Social Me

  • Case Manager

    2 days ago

    Johannesburg, South Africa Medical Protection Society Full time

    Job Introduction The Member Cases and Claims Division is at the forefront of protecting the careers, reputation and financial risk of our members worldwide. The purpose of the role is to support the provision of excellent case handling services for members which is trusted and valued and provides fair treatment and outcomes. The role will do this by managing...

  • Medical Advisor

    5 days ago

    Johannesburg, South Africa Medical Placements Full time

    EE Position - The position report directly to the HOD: Hospital Benefit Management. **THE IDEAL CANDIDATE SHOULD HAVE**: - Must be a Medical Doctor registered with Health Professions Council of South Africa (HPCSA). - Medical indemnity insurance will be an added advantage. - Must have sound knowledge of the Medical Aid Industry, Rules & Regulations, and...

  • Case Manager/ Social Worker

    8 hours ago

    Johannesburg, Gauteng, South Africa Aristo Sourcing Full time

    Our client is seeking a dedicated Case Manager/ Social Worker to coordinate and manage care plans for patients with chronic or complex medical conditions. This role involves working closely with healthcare providers, insurance companies, and patients to ensure optimal care and efficient use of healthcare resources.The Case Manager/ Social Worker will play a...

  • Case Management Lead

    2 weeks ago

    Johannesburg, South Africa Complement Recruitment Full time

    Complement Recruitment are recruiting for a Case Management Lead for a permanent position based in Sandton, Johannesburg, Gauteng. Our client is looking for an experienced, commercially minded and operationally strong case management lead with a proven track record of implementing and streamlining projects and making sure they have high impact for the...

  • Healthcare Operations Manager

    7 hours ago

    Johannesburg, Gauteng, South Africa Aristo Sourcing Full time

    About the RoleAristo Sourcing is seeking a highly motivated Healthcare Operations Manager to oversee the coordination and management of care plans for patients with chronic or complex medical conditions. The ideal candidate will have a strong background in healthcare operations, excellent leadership skills, and the ability to work effectively as part of a...

  • Case Manager

    2 days ago

    Johannesburg, South Africa MHR Full time

    **Job Advert Summary**: MHR is urgently looking for a **Registered Nurse Case Manager** with **Disease Management experience.** This is a **permanent opportunity** at a well-known medical aid** **in** Randburg** in** Johannesburg**. **Minimum Requirements**: - 5 years of case management and disease management experience - Minimum of 3 years’ experience...

  • Case Manager

    2 weeks ago

    Johannesburg, South Africa LetsLink Pty Ltd Full time

    Role Title: Case Manager Role Summary: Are you a healthcare professional looking to make a significant impact in patient care and financial risk management? If so, we have an exciting opportunity for you to join the team of a private hospital based in Gauteng as a Case Manager. In this role, you will leverage your clinical knowledge and expertise to ensure...

  • Clinical Case Consultant

    5 days ago

    Johannesburg, South Africa Kaelo Full time

    Company Description Kaelo provides essential healthcare solutions ensuring the physical and psychosocial wellbeing of all South Africans towards lasting social change. Kaelo meets the Healthcare needs of Corporate and Retail clients across South Africa - products offerings include Medical Insurance, Medical Aid, Gap Insurance, Kaelo Money and employee...

  • Medical Officer

    2 weeks ago

    Johannesburg, South Africa AIDS HEALTHCARE FOUNDATION Full time

    **JOB SUMMARY** The incumbent, reporting to the Provincial Medical Manager and working closely alongside nurses, will be expected to provide expert medical care, advice, diagnosis and treatment of all patients in care at all AHF-supported clinics within the allocated district/subdistrict in the province, and sometimes remotely to other provinces where...

  • Case Manager

    6 days ago

    Johannesburg, South Africa Belmar Personnel Full time

    1. **Qualifications**: - Matric - Registered Nursing diploma - Valid membership of SANC - Claims and Forensic Risk management certification - Registration with the Association of Certified Fraud Examiners (ACFE SA) - A completed RE5 certificate essential 2. **Skills and Experience**: - At least 2-3 years experience in a similar role. - MIP Application...

  • Case Manager

    4 weeks ago

    City of Johannesburg Metropolitan Municipality, South Africa Clinix Health Group Ltd Full time

    Job title : Case ManagerJob Location : Gauteng, SowetoDeadline : March 06, 2025Quick Recommended Links Jobs by Location Job by industries Job Summary: 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...

  • Universal Healthcare Executive Director

    4 days ago

    Johannesburg, Gauteng, South Africa Universal Healthcare Full time

    Company OverviewUniversal Healthcare is a purpose-driven company dedicated to improving health and well-being through evidence-based medicine and a caring approach.We strive to promote wellness for those who are well and support healthcare professionals in their practice.In addition to our core values, we have diversified into digital health and software...

  • Hospital Case Manager

    2 weeks ago

    Johannesburg, South Africa Kaelo Full time

    Company Description **About Kaelo** Kaelo provides essential healthcare solutions ensuring the physical and psychosocial well-being of all South Africans towards lasting social change. Insurance products with limited medical benefit need close supervision for casualty and admission cases. **Job Description**: Load all hospital related cases for casualty...

  • Medical Scheduler

    4 weeks ago

    Johannesburg, South Africa Healthcare Hiring Firm Full time

    This is a REMOTE job. We are a leading Pulmonary and Sleep Specialist practice providing comprehensive care, including primary and urgent care services, across two locations in North Carolina. We are looking for a dedicated and customer-focused Medical Scheduler to join our Patient Engagement Department remotely. As a Medical Scheduler, you will be the...

  • Case Manager

    2 days ago

    Johannesburg, South Africa SD Consult Full time

    **Role Summary** The Case Manager utilizing clinical knowledge and expertise, mitigates financial risk through comprehensive and accurate coding of hospital events, communication with funders on justification for hospitalization level of care and length of stay. **Key Word Output and Accountabilities**: - Monitor and action risk related to medical aid...

  • Renal Case Manager

    5 days ago

    Johannesburg, South Africa Medpharm Recruitment Full time

    A reputable Mananaged Healthcare Client is seeking a Renal Case Manager to join their team in Johannesburg. **Duties**: - To manage the spending of member funds by means of clinical interventions and managed care protocols. **Requirements**: - Registered Nurse (SANC) - 5 years experience in Renal Dialysis - Coding experience (advantage) - 1 year...

  • Back Office Case Manager

    3 weeks ago

    Johannesburg, Gauteng, South Africa Fusion Personnel Full time

    Requirements:Nursing qualification (Registered or Enrolled Nurse).3 to 5 years of nursing experience, with back-office or case management experience preferred.Knowledge of medical scheme regulations, ICD-10 coding, tariffs, and case management protocols.Strong attention to detail, communication, and administrative skills.Computer literacy, including...

  • Case Manager

    3 days ago

    Johannesburg, South Africa Mass Staffing Projects Full time

    **Requirements**: - Degree/Diploma in Nursing - Minimum 4 years nursing experience in a multidisciplinary hospital environment - Intensive Care nursing experience is an advantage - Hospital or Medical Scheme Case Management an advantage - Experience in ICD 10 and CPT 4 coding an advantage

  • Case Manager

    1 week ago

    Johannesburg, South Africa BQuad Solutions Full time

    Manage calls from Hospital Case Managers regarding authorisations for procedures in hospital, **trauma, casualty**, GP or dental rooms - Case management from issuing a guarantee of payment to final discharge and follow up treatment - Manage clinical risk to decrease claims over utilisation - Pre-authorisation of GP visits per benefit option rules - Classify...

  • Litigation Case Manager

    4 days ago

    Johannesburg, South Africa AristoSourcing Inc. Full time

    AristoSourcing LLC is an Outsourcing company highly focused on the Digital Marketing Industry. Our company has been in the industry for more than 7 years. We hired and referred skilled and experienced Virtual Assistants to work and collaborate directly with our respective clients from different parts of the globe that offer 100% remote work for talented and...