Clinical Case Manager

4 weeks ago


Johannesburg, Gauteng, South Africa Edge Executives Full time
Job Summary

Edge Executives is seeking a highly skilled Clinical Case Manager to join our team. As a key member of our healthcare team, you will be responsible for managing hospital admissions, conducting clinical assessments, and coordinating with healthcare providers to ensure the most efficient and cost-effective care is delivered to patients.

Key Responsibilities
  1. Case Management
  • Review hospital admissions to ensure clinical appropriateness and adherence to scheme rules and clinical guidelines.
  • Conduct pre-admission, admission, and discharge planning to optimize patient outcomes and reduce length of stay.
  • Coordinate with healthcare providers to ensure seamless care transitions and cost-effective resource utilization.
Clinical Assessments and Authorisations
  • Perform comprehensive clinical assessments to inform treatment decisions and ensure alignment with clinical guidelines.
  • Approve or recommend alternative care options based on medical necessity and scheme rules.
  • Authorise hospital admissions, procedures, and specialist treatments in accordance with policy and clinical protocols.
Collaboration with Providers
  • Communicate regularly with healthcare providers to review patient progress and treatment plans.
  • Facilitate case conferences to improve patient outcomes and ensure integrated care.
  • Liaise with multi-disciplinary teams to ensure coordinated patient care and support appropriate care pathways.
Cost and Resource Management
  • Monitor and manage hospitalisation costs, treatment expenses, and post-discharge care in alignment with scheme financial goals.
  • Identify cost-saving opportunities while ensuring high-quality patient care.
  • Monitor adherence to length of stay targets, care levels, and resource utilization to avoid unnecessary hospital stays and over-treatment.
Risk and Compliance Management
  • Ensure compliance with clinical and regulatory guidelines, scheme rules, and hospital policies.
  • Identify and manage clinical risks to implement interventions that align with scheme objectives.
  • Maintain accurate and timely documentation of case management activities and comprehensive records for auditing and reporting purposes.
Reporting and Documentation
  • Prepare and maintain detailed case reports for each patient, documenting clinical interventions, hospital admissions, length of stay, and discharge planning.
  • Provide regular updates to management on key case management metrics, including costs, compliance, and patient outcomes.
Requirements
  • Education: Registered Nurse or Healthcare Professional with relevant clinical qualifications.
  • Professional Membership: Registered with the South African Nursing Council (SANC) or relevant professional body.
  • Experience: Minimum of 3-5 years of clinical experience in a hospital environment, with at least 2 years of experience in case management or managed care.
  • Skills: Proficiency in clinical assessments, hospital billing, and discharge planning. Understanding of healthcare systems and regulations.

  • Clinical Case Manager

    4 weeks ago


    Johannesburg, Gauteng, South Africa Palesa Mbali Group Full time

    Job Title: Clinical Case ManagerJob Summary:We are seeking a skilled Clinical Case Manager to join our team at Palesa Mbali Group. As a Clinical Case Manager, you will be responsible for ensuring the clinical appropriateness of care at the lowest possible cost without compromising quality of care.Key Responsibilities:Assess the quality of information...

  • Clinical Case Manager

    2 weeks ago


    Johannesburg, Gauteng, South Africa Palesa Mbali Group Full time

    Job Title: Clinical Case ManagerJob Summary: We seek an experienced Clinical Case Manager to oversee the clinical appropriateness of care at the lowest possible cost without compromising quality of care.Key Responsibilities:Ensure clinical approval of authorized treatment plans.Manage the risk to the client by assessing the quality of information received...

  • Clinical Case Manager

    4 weeks ago


    Johannesburg, Gauteng, South Africa Edge Executive Search Full time

    Case ManagerOur client is seeking a dedicated and experienced Case Manager to join their team and manage the spending of member funds through clinical interventions and the application of managed care protocols.Key Qualifications:Nursing Degree/DiplomaProfessional Registered Nursing Sister with a valid and up-to-date registration with the South African...

  • Case Manager

    4 weeks ago


    Johannesburg, Gauteng, South Africa Edge Executives Full time

    Job SummaryEdge Executives seeks a skilled Case Manager to join our team. As a key member of our healthcare team, you will be responsible for managing hospital admissions, conducting clinical assessments, and coordinating care with healthcare providers.Key ResponsibilitiesCase ManagementReview hospital admissions to ensure clinical appropriateness and align...


  • Johannesburg, Gauteng, South Africa Edge Executive Search Full time

    Case Manager OpportunityOur client is seeking a dedicated and experienced case manager to join their team and manage the allocation of member funds through evidence-based clinical interventions and the application of managed care protocols.Key Responsibilities:Develop and implement effective case management plans to optimize member outcomes.Collaborate with...


  • Johannesburg, Gauteng, South Africa Edge Executive Search Full time

    Key QualificationsWe are seeking a dedicated and experienced Case Manager to join our client's team and manage the spending of member funds through clinical interventions and the application of managed care protocols.Key ResponsibilitiesMinimum of 5 years of general medical and surgical nursing experience in the private sector.ICU training and/or at least 1...


  • Johannesburg, Gauteng, South Africa Edge Executive Search Full time

    We are seeking an experienced Clinical Management Specialist to join our team at Edge Executive Search. This role requires a skilled professional with a strong background in case management and clinical interventions.The successful candidate will have a minimum of 5 years of general medical and surgical nursing experience in the private sector, including ICU...

  • Medical Case Manager

    2 weeks ago


    Johannesburg, Gauteng, South Africa Edge Executive Search Full time

    Edge Executive Search is seeking a highly skilled Medical Case Manager to join their team. The ideal candidate will possess a Nursing Degree/Diploma and be a Registered Nursing Sister with a valid and up-to-date registration with the South African Nursing Council.This is a challenging and rewarding role that requires strong clinical assessment and...


  • Johannesburg, Gauteng, South Africa Talent Evolution (Pty) Ltd Full time

    Nurse Case Manager Job DescriptionTalent Evolution (Pty) Ltd is seeking a skilled Nurse Case Manager to provide comprehensive and professional telephonic health advisory services to patients.Key Responsibilities:Provide patient-focused care and guidance on the phone or online, including accurately assessing needs, delivering or directing to the appropriate...

  • Nurse Case Manager

    4 weeks ago


    Johannesburg, Gauteng, South Africa Talent Evolution Full time

    Job Title: Nurse Case Manager Job Summary: We are seeking a skilled and compassionate Nurse Case Manager to join our team at Talent Evolution. As a Nurse Case Manager, you will play a vital role in providing patient-focused care and guidance to individuals in need of telephonic health advisory services. Responsibilities: * Provide comprehensive and...


  • Johannesburg, Gauteng, South Africa AJ Personnel Full time

    About the RoleWe are seeking a highly skilled Clinical Data Specialist to join our team at AJ Personnel. As a key member of our team, you will be responsible for collecting and accurately reporting clinical data for surveillance and research purposes from patients at designated sites.ResponsibilitiesLiaise closely with provincial, district, and facility...

  • Clinical Supervisor

    2 weeks ago


    Johannesburg, Gauteng, South Africa St. John's Riverside Hospital Full time

    Healthcare Leadership OpportunitySt. John's Riverside Hospital, a leader in providing high-quality health care, seeks a skilled Clinical Supervisor to oversee the administration of a specific treatment unit.Responsibilities:Supervise Social Workers, Counselors, students, and volunteers to achieve outpatient quality goals.Ensure compliance with hospital...


  • Johannesburg, Gauteng, South Africa Edge Executives Full time

    Job Title: Pre-Authorisation ConsultantEdge Executives is seeking a highly skilled Pre-Authorisation Consultant to join our team. As a key member of our clinical governance team, you will be responsible for ensuring that hospital admissions and procedures are appropriately authorised and managed.Key Responsibilities:Pre-Authorisation of Hospital Admissions...


  • Johannesburg, Gauteng, South Africa Kaelo Full time

    Clinical Support SpecialistThe Clinical Support Specialist is a key role within Kaelo Lifestyle, responsible for providing high-quality telephonic counselling services to clients. This specialist will establish suitable treatment plans, execute these plans through quality telephonic counselling, and manage longer-term cases referred by the inbound EAP...


  • Johannesburg, Gauteng, South Africa Palesa Mbali Group Full time

    **Position Purpose:**To optimize patient care and minimize costs, we seek a highly skilled Case Manager In Hospital to coordinate care in our allocated facilities.**Responsibilities:**The successful candidate will have a comprehensive understanding of hospital processes and the importance of making cost-effective decisions.Key responsibilities will...

  • Clinical Manager

    2 weeks ago


    Johannesburg, Gauteng, South Africa Edge Executive Search Full time

    Job Title: Clinical ManagerWe are seeking an experienced Clinical Manager to join our team at Edge Executive Search.Key Responsibilities:Manage member funds through clinical interventions.Apply managed care protocols to optimize resource utilization.Collaborate with multidisciplinary teams to deliver patient-centered care.Qualifications:Nursing...

  • Clinical Associate

    3 days ago


    Johannesburg, Gauteng, South Africa AJ Personnel Full time

    Job OverviewWe are seeking a highly skilled Clinical Associate - Medical Professional to join our team at AJ Personnel. This exciting opportunity will allow you to utilize your clinical expertise in recruitment, research, and patient care.About the RoleThe ideal candidate will possess a strong background in healthcare with a focus on medical practice. The...


  • Johannesburg, Gauteng, South Africa Dis-Chem Pharmacies Full time

    About the Role: We are seeking a qualified and experienced Registered Nursing Practitioner to join our team in Rosebank as a Primary Health Care Clinic Sister. The successful candidate will be responsible for managing and operating a profitable primary health care clinic situated within a pharmacy, ensuring excellent patient care and service delivery.Key...

  • Clinical Supervisor

    3 weeks ago


    Johannesburg, Gauteng, South Africa St. John's Riverside Hospital Full time

    Job SummarySt. John's Riverside Hospital is seeking a highly skilled Clinical Supervisor to oversee the administration of our treatment units. As a key member of our team, you will be responsible for supervising social workers, counselors, and students, as well as ensuring compliance with hospital and regulatory documentation requirements.Key...


  • Johannesburg, Gauteng, South Africa Kontak Recruitment Full time

    Clinical Research Operations ManagerWe are seeking a highly skilled Clinical Research Operations Manager to join our team at Kontak Recruitment. The ideal candidate will have a background in clinical research operations and experience in pharmaceutical companies or Contract Research Organizations (CROs).Key Responsibilities:Implement and manage the quality...