Case Manager

A job opportunity exists for the right candidate in Western Cape

The Department of Health and Wellness is guided by the principles of Employment Equity. Candidates with disabilities are encouraged to apply and an indication in the regard will be appreciated.

Note: No payment of any kind is required when applying for any of the positions advertised by the Western Cape Government.

Case Manager

Employment Type: Permanent

Reference No: RHS3/2026

George Regional Hospital, Chief Directorate: Metro Health Services

Experience:

Appropriate experience in Case Management/Medical Aid Environment and Managed Health Care policies and protocols. Appropriate experience in ICD-10 diagnostic and procedural code assignment.

Minimum Educational Qualification:

Appropriate three-year health related National Diploma/Degree registrable with the Health Professions Council of South Africa (HPCSA) or South African Nursing Council (SANC).

Duties (Key Result Areas/Outputs):

Efficiently and effectively communicate and update clinical information for externally funded patients as well as the evaluation and monitoring of ICD 10- Coding for externally funded patients. Perform hospital Case Management functions w.r.t. pre-authorisation and authorisation, benefit management, and review of clinical information for externally funded clients as well as providing quotes for elective procedures. Identify PMB diagnosis or ICD-Code to ensure claims are paid from the correct benefit, as well as when benefits are exhausted. Efficient and effective interpretation and implementation of Case Management policies, protocols, and procedures including the conducting of clinical audits pf patient accounts to ensure accuracy of invoices for the submission to external funders. Supervision of staff as well as co-ordinating the workflow processes between clinical and admin personnel relating to Case management which include ICD10-coding, PMB's and account queries as well as quality client care and compilation of statistical reports for hospital management. Provide assistance to Hospital Fees staff regarding medical scheme authorisations, liaising with medical schemes and MediKredit regarding rejected claims as well as in terms of follow-up of outstanding medical scheme and state department balances, account queries and provide quotations to H2, H3 and Foreign patients.

Competencies (Knowledge/ Skills):

Knowledge of Uniform Patient Fee Schedule, ICD-10 and the Medical Schemes Act 131 of 1998 and Regulations i.e. (PMB Legislation). Knowledge of EDI (Electronic Data Interchange), Managed Health Care standards and patient billing. To monitor the quality and ensure accuracy of Diagnostic and Procedural Coding. Computer Literacy (MS Word/Excel). Good communication skills (verbal and written).

Enquiries:

Ms L Kombrink tel. no.:

Note:

No payment of any kind is required when applying for this post. Shortlisted candidates may be subjected to a practical. The pool of applications will be considered for vacancies within George Hospital, for a period of three months from the date of the advert, provided that the job title, core functions, inherent requirements, and salary level are the same as those of the advertised post.

Remuneration:

R R per annum Annual salary plus service benefits (13th cheque, employer's contribution to the pension fund, housing and medical aid allowance).

Starting Date:

1/16/2026 12:00:00 AM

NOTICE TO ALL

Candidates may be subjected to a competency test. No payment of any kind is required when applying for this post. As directed by the Department of Public Service and Administration, applicants must note that further checks will be conducted once they are shortlisted and that their appointment is subject to positive outcomes on these checks, which include security clearance, qualification verification, criminal records and previous employment.

• It will be expected of shortlisted candidates to be:
• available at the venue on the time and date as determined by the Department and
• bring along recently (not older than 6 months) certified copies of your Identity Document (ID), driver's license (if applicable for the post), qualification and/or proof of registration at relevant statutory body. Failure to adhere to the aforementioned may lead to his/her application being disqualified and not further considered.

Closing date: 1/30/2026 12:00:00 AM