Hospital Case Manager x1
Job Details
- Job Title: Hospital Case Manager
- Company: Mediclinic Southern Africa
- Hospital: Mediclinic Hoogland
- Location: Bethlehem, Free State, South Africa
- Employment Type: Permanent
- Workplace: On-site
- Reference Number: 72371
- Number of Positions: 1
- Closing Date: 5 August 2026
Job Description
Mediclinic Hoogland is looking for a dedicated and detail-oriented Hospital Case Manager to coordinate the hospital case management process and ensure effective communication between healthcare professionals, medical funders, and patients. The successful candidate will provide accurate and timely clinical information to facilitate appropriate patient care while minimising financial risk and ensuring compliance with hospital policies and medical aid requirements.
This role is ideal for a healthcare professional with strong clinical knowledge, case management expertise, and an understanding of medical aid funding, clinical coding, and healthcare regulations.
Key Responsibilities
- Coordinate the hospital case management process to ensure effective patient care and efficient resource utilisation.
- Manage patient stays to minimise financial risk while maintaining quality clinical outcomes.
- Ensure compliance with case management procedures, contracts, hospital policies, and legal requirements.
- Facilitate the accurate and timely finalisation of patient cases to support reimbursements from medical funders.
- Communicate consistently with medical schemes and funders through approved case management channels.
- Ensure compliance with Level 3 clinical coding standards.
- Request and manage authorisations for patient admissions, level of care, and length of stay.
- Maintain accurate clinical documentation and case management records.
- Utilise electronic case management systems and funder portals for authorisations, updates, and troubleshooting.
- Monitor workflow and manage deviations in the case management process.
- Lead and manage the Case Management team where applicable.
- Collaborate with multidisciplinary healthcare teams to ensure effective patient outcomes.
Minimum Requirements
Applicants should meet the following requirements:
Essential Qualifications
- Clinical qualification.
Preferred Qualifications
- Registered Nurse (RN) or Professional Nurse qualification.
- Qualified Paramedic.
Experience
- Minimum of 3 years’ experience in a clinical role.
- Preferred:
- Experience in Theatre and/or Intensive Care Unit (ICU).
- Medical aid or healthcare funding experience.
- Experience within a private healthcare environment.
- Experience as an Intermediate Life Support (ILS) or Advanced Life Support (ALS) Paramedic.
Knowledge and Skills
Applicants should possess knowledge of:
- Human anatomy, physiology, and medical terminology.
- Scientific nursing principles and clinical processes.
- Medical aid funder contracts and authorisation requirements.
- Clinical coding standards, including Level 3 coding guidelines.
- Authorisation processes for:
- Level of care
- Length of stay
- High-cost stock
- Short payments
- Electronic funder portals and case management systems.
- Microsoft Office and hospital or practice management systems.
- Patient administration policies and procedures.
- Relevant healthcare legislation, including the Consumer Protection Act and Prescribed Minimum Benefits (PMB).
- Case management workflows and reimbursement processes.
Skills and Competencies
The ideal candidate should demonstrate:
- Strong analytical and problem-solving skills.
- Excellent clinical assessment and decision-making abilities.
- Effective communication and interpersonal skills.
- Strong organisational and time management skills.
- High attention to detail and accuracy.
- Ability to work effectively under pressure in a fast-paced healthcare environment.
- Sound understanding of healthcare funding and reimbursement processes.
- Ability to collaborate with multidisciplinary teams.
- Strong leadership and people management skills where applicable.
- Commitment to patient-centred care, compliance, and continuous quality improvement.