Case Manager

1 week ago

Cape Town, 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** Cape Town City Centre**.

**Minimum Requirements**:

- 5 years of case management and disease management experience
- Minimum of 3 years’ experience in high-risk patient case management or care coordination program within a medical scheme or managed care environment
- National Diploma in Nursing (General, Community Health, Midwifery, and Psychiatry)
- Diploma in Intensive care will serve as an added advantage
- Registered with SANC as a Registered Nurse

**Knowledge**
- Thorough medical knowledge
- Excellent Medical Aid Industry and claims assessing knowledge
- Good working knowledge of ICD10 coding and other clinical coding
- Clinical Risk Management, Risk Management practices and principles knowledge
- Sound knowledge of relevant legislation and regulatory frameworks

**Skills**
- Proven Business Acumen skills
- Excellent verbal and written communication skills
- Project Management skills
- Managed healthcare
- Problem Solving, Judgement and Decision-Making skills

**Attributes**
- Resilient
- Detail orientated
- Results and quality focused
- Compliance driven
- Innovative thinking
- Client-centric
- Analytical thinking

**Duties and Responsibilities**:
The Case Manager is responsible for developing and implementing intensive, multifaceted risk management interventions on a patient-specific basis with the purpose of preventing or reducing the medical schemes’ exposure to potentially high-cost members (in/out of hospital) who have been identified and risk-stratified through claims analyses and clinical criteria.

**Key areas of responsibility**
- Use prepared lists of potentially high-risk patients, identified and stratified according to the level of risk, to prioritise and schedule risk management interventions.
- Further provide hospital utilisation management, education/training, and other clinically based activities to coordinate care between the medical scheme/managed care organisation, members, providers and the community.
- Perform desk research to analyse the patient’s medical profile and claiming behaviour to develop possible action plans, ensuring that the patient receives the level and extent of care required for the optimal management of his/her condition(s), possible action plans for improving patient adherence to treatment, as well as possible actions plans regarding lifestyle measures required to assist in mitigating the clinical risk.
- Engage telephonically with patients to agree on strategies, and specific and detailed action plans to improve the patient’s medical prognosis and optimal disease control.
- Identify areas where the member requires education and support and provide such.
- Engage with the third-party Managed Care Partners and Medical Providers to request specific health information to provide an update of a member's healthcare status and facilitate registration on the appropriate programs and authorisation of care baskets.
- Set achievable goals and targets for the member to achieve, i.e. visit their doctor every 6 months, have specific investigations performed at scheduled dates, lose a specified number of kilograms in a defined time period, reduce their blood pressure to 120/80, reduce their HbA1c to a specific level by a certain date, etc.
- Ensure that the patient understands how to take their medicines and the need to adhere to their treatment.
- Help the patient make any arrangements necessary to receive optimal care and to adhere to their treatment plan and schedule.
- Identify if the patient needs to be referred to specialist care or have a second opinion, and assist in facilitating or arranging this.
- Arrange for patients to join support groups and enroll on the scheme’s exercise program, dietitian program, etc., as the case may be.
- Monitor and track adherence to the agreed action plan, per patient, through claims analyses and ongoing patient engagement.
- Perform site visits, where required, for high-cost patients in hospital to contain costs, coordinate and arrange cost-effective care in collaboration with the treating doctor, and facilitate discharge planning.
- Assist with Health Risk Management Monitoring and Management of hospital re-admissions.
- Support the Clinical Manager and HOD on any projects related to risk management.
- Develop and maintain a general clinical understanding of Tariff coding, ICD, CPT, SAMA, RPL and National Pharmaceutical Product Interface (NAPPI) codes and how these affect clinical billing rules.
- Assist in reviewing policies, protocols, tariffs, and NAPPI codes from a clinical and financial position.
- Provide the Medical Advisor with supporting documents for motivation for additional service payments on special cases.
- Research medical literature and use evidence-based principles to generate enhancements in funding protoc

  • Case Manager

    1 week ago

    Cape Town, Western Cape, South Africa Intercare Group Full time

    ABOUTIntercare is a dynamic healthcare company focusing on offering value-based healthcare to patients. As ambassadors of the Intercare brand, everything we do is guided by our purpose to make people feel better. Our shared values of People-centred, Integrity, Inclusivity, Excellence and Innovation define what we believe and who we are.Intercare SSISA...

  • Case Manager

    7 days ago

    Cape Town, Western Cape, South Africa Intercare Group Full time

    Direct message the job poster from Intercare GroupHuman Capital Business Partner | Payroll Specialist @ Intercare GroupABOUTIntercare is a dynamic healthcare company focusing on offering value-based healthcare to patients. As ambassadors of the Intercare brand, everything we do is guided by our purpose to make people feel better. Our shared values of...

  • Case Manager

    4 weeks ago

    Cape Town, Western Cape, South Africa Intercare Group South Africa Full time

    Job title : Case Manager - SSISA Rehabilitation HospitalJob Location : Western Cape, Cape TownDeadline : March 27, 2025Quick Recommended LinksJobs by Location Job by industries CRITICAL OUTPUTSParticipate in recruiting referring Doctors and other members of the professional team. Participate in recruiting referring Doctors, other members of the...

  • Case Management Professional

    6 days ago

    Cape Town, Western Cape, South Africa Morae Full time

    Job OverviewMorae is seeking a highly skilled Complaints Manager to join our team on a 6-month contract basis.Key Accountabilities:Investigate complaints and ensure the timely and effective resolution of cases.Provide detailed reports on case progress, findings, and outcomes to senior management.Collaborate with various internal departments to resolve issues...

  • Aboriginal Case Manager

    18 hours ago

    Cape Town, Western Cape, South Africa Carrol Boyes Full time

    We are seeking an Aboriginal Family Violence Case Manager to contribute to alleviating the effects of domestic and family violence experienced by First Nations women and children.The successful candidate will provide quality service responses, informed by a deep understanding of First Nation cultural values and needs.Key responsibilities include undertaking...

  • Case Manager

    3 weeks ago

    Cape Town, South Africa TRANSGENERATIONAL Full time

    **Requirements**: 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...

  • Immigration Case Manager

    3 days ago

    Cape Town, Western Cape, South Africa Black Pen Recruitment Full time

    Immigration Case Manager (South African Immigration Law)Black Pen Immigration is a leading immigration consultancy specializing in providing expert legal and administrative support for individuals and businesses navigating South African immigration processes. Our team is committed to delivering exceptional service, ensuring smooth transitions for clients...

  • Hospital Case Manager

    2 weeks ago

    Cape Town, South Africa MHR Full time

    **Job Advert Summary**: MHR is urgently looking fo**r **an experienced **Hospital Case Manager** to work at a private hospital in **Panorama** in** Cape Town** ( Western Cape province). This is an opportunity to work **daily fixed shifts** until **end of March**. **Working hours**: 07:30 - 16:30 **Minimum Requirements**: **Requirements**: - **Must be...

  • Immigration Case Manager

    2 days ago

    Cape Town, Western Cape, South Africa Black Pen Recruitment Full time

    Black Pen Immigration is a leading immigration consultancy specializing in providing expert legal and administrative support for individuals and businesses navigating South African immigration processes. Our team is committed to delivering exceptional service, ensuring smooth transitions for clients seeking visas, work permits, and permanent residency...

  • Immigration Case Manager

    2 days ago

    Cape Town, Western Cape, South Africa Black Pen Recruitment Full time

    Black Pen Immigration is a leading immigration consultancy specializing in providing expert legal and administrative support for individuals and businesses navigating South African immigration processes. Our team is committed to delivering exceptional service ensuring smooth transitions for clients seeking visas, work permits, and permanent residency...

  • Case Manager

    2 days ago

    Cape Town, Western Cape, South Africa Mass Staffing Projects Full time

    New opening in Cape Town Looking for a Case Manager in Private Healthcare to serve as the liaison between the hospital and medical aid.Requirements:Relevant Degree or Diploma in Nursing / Enrolled Nurse qualificationExperience in Clinical Coding essentialSound financial knowledge and the ability to interpret financial dataIf you are interested in this...

  • Technical Case Officer: Case Management, Ref No

    1 week ago

    Cape Town, South Africa Western Cape Government Full time

    **Job Purpose**: The Department of Infrastructure, Western Cape Government has an opportunity for a suitably qualified and competent individual to supply and render administrative and logístical support to the Rental Housing Tribunal and promote stable relationships between landlords and tenants in the rental housing sector within the context of integrated...

  • Experienced Casings Senior Manager

    1 week ago

    Cape Town, South Africa Recruitment Matters (Pty) Ltd Full time

    **Responsibilities**: - Strategic Leadership: Develop and implement strategic plans to enhance productivity, efficiency, and profitability in the casings department. - Operations Management: Oversee the day-to-day operations of the casings production, including planning, manufacturing, quality control, and logistics. - Team Management: Lead, motivate, and...

  • Case Manager

    2 weeks ago

    Cape Town, South Africa Staff co South Africa Full time

    Tokai, Southern Suburbs Private Hospital Sector **Requirements**: - A Qualified SANC Registered Nurse (must have proof of Indemnity Cover) - At least 3 years relevant experience as a Case Manager - Previous experience in a Private Hospital and/or Medical Aid background in Case Management Department - Must have knowledge of ICD 10 and CPT Coding, PMB...

  • Case Management Professional Job

    1 day ago

    Cape Town, Western Cape, South Africa Mvg Recruitment Specialists Full time

    Job Description:As a Disease Risk Case Manager at Horizons, you will be responsible for enhancing our product through innovative strategies and approaches. This includes mentoring colleagues, participating in Corporate Wellness Days, and managing automated solutions to streamline processes.Key Performance Indicators (KPIs):Product Enhancement: Achieve...

  • Disease Risk Case Manager

    3 days ago

    Cape Town, Western Cape, South Africa MVG Recruitment Specialists Full time

    Position: Disease Risk Case Manager (DRM)Qualifications: Diabetic Education or Mental Health QualificationsExperience: 2-5 years in specialized fieldLocation: Cape Town/ JohannesburgType: Full-time – In OfficeAre you an innovative and dynamic thinker with a passion for making a difference in managed healthcare? Our large Managed Healthcare client is...

  • Case Manager

    6 days ago

    Cape Town, Western Cape, South Africa Horizons Full time

    We are seeking a seasoned professional to join our team at Horizons as a Disease Risk Case Manager (DRM).The ideal candidate will have a strong background in Diabetic Education or Mental Health and at least 2 years' experience within Managed Healthcare.About the Role:This role offers a unique opportunity for a talented individual to leverage their skills and...

  • Case Manager

    2 weeks ago

    Cape Town, South Africa MHR Full time

    **Job Advert Summary**: MHR is urgently looking for a **Registered Nurse Case Manager** with **oncology**-**related treatment** **experience**. This is a **permanent opportunity** at a well-known medical aid** **in** **Cape Town City Centre**. **Working hours**:8:00 - 16:00 | **Start date**: As soon as possible **Minimum Requirements**: - Registered with...

  • Case Worker

    1 week ago

    Cape Town, South Africa The A21 Campaign Full time

    **WHO WE ARE**: **A21 is a nonprofit organization fueled by radical hope that human beings everywhere will be rescued from bondage and completely restored. We are the abolitionists of the 21st century, and we work to free people in slavery and disrupt the demand.** For 15 years now, we've rolled up our sleeves and set our feet to action. Why? Because in a...

  • Disease Risk Case Manager Position

    1 day ago

    Cape Town, Western Cape, South Africa Mvg Recruitment Specialists Full time

    Job Title: Disease Risk Case ManagerAbout the Role:Horizons is seeking a highly skilled and experienced Disease Risk Case Manager to join our team. The successful candidate will be responsible for enhancing our product through innovative strategies and approaches, mentoring colleagues, participating in Corporate Wellness Days, and managing automated...