CASE MANAGER CITY HOSPITAL

PURPOSE OF POSITION

To coordinate and manage patient care, funding, and discharge processes to ensure quality clinical outcomes, appropriate resource utilization, accurate reimbursement, and compliance with hospital and medical scheme requirements.

KEY PERFORMANCE AREAS

• Support the implementation of the hospital's Case Management strategy and contribute to departmental objectives.
• Coordinate multidisciplinary care and discharge planning by collaborating with patients, families, medical practitioners, nursing staff, and medical schemes.
• Manage relationships with funders, ensuring timely communication, authorization management, and resolution of funding queries.
• Apply clinical knowledge to accurately code diagnoses and procedures using ICD-10 and CPT standards.
• Monitor patient admissions, length of stay (LOS), level of care (LOC), and discharge processes to ensure appropriate utilization and reimbursement.
• Maintain service level agreements (SLAs) through timely submission of clinical updates, supporting documentation, and discharge information.
• Manage debtors' rejections, age analysis, and Day Sales Outstanding (DSO) targets to optimize revenue cycle performance and minimize payment delays.
• Identify and mitigate financial and clinical risks related to authorizations, exclusions, extended stays, prosthetic limits, and reimbursement structures.
• Ensure compliance with medical scheme rules, coding standards, hospital policies, and quality assurance requirements.
• Contribute to continuous improvement initiatives by monitoring quality indicators, reporting variances, and supporting best-practice patient care.

Minimum Requirements

• Registration with the SANC as a RN / EN.
• Must be computer literate.
• Must have Billing / Auditing experience essential.
• Experience in a multidisciplinary hospital environment.
• ICD 10 and CCSA coding experience is required.
• Must have experience liaising with medical aids, doctors, and patients.
• Successful candidate should be available immediately.

Skills

• Must have excellent telephone skills.
• Must possess excellent inter-personal skill.
• Sound understanding of medical scheme funding, reimbursement models, and authorization processes.
• Excellent stakeholder engagement and communication skills.
• Ability to manage multiple priorities, meet deadlines, and work collaboratively within a multidisciplinary environment.
• Strong analytical, administrative, and problem-solving abilities with a focus on quality care and financial sustainability.

NB: Only short-listed candidates will be contacted.

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By applying to this advert, you consent to JMH (Pty) Ltd collecting and processing your personal information for the purpose of determining your eligibility for the advertised position.

If unsuccessful, your personal information is securely destroyed and is not retained by the company.

Preference will be given to employees from the designated group in line with the Employment Equity Act.