Case Manager (Permanent position)

A job opportunity exists for the right candidate in Western Cape

Employment Type:

Permanent

Reference No:

HO126/2026

Location:

Directorate: Management Accounting, Head Office, Cape Town (Based at Stikland)

REMUNERATION

R 413 001 - R 486 501 per annum Annual salary plus service benefits (13th cheque, employer's contribution to the pension fund, housing and medical aid allowance).

STARTING DATE

14 Aug 2026

CLOSING DATE

• PLEASE NOTE:

28 Aug 2026, 5:00 pm

EMPLOYMENT EQUITY

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.

EXPERIENCE

Appropriate experience in Case Management/Medical Aid Environment or Revenue Generation. Appropriate experience in ICD-10 Code assignment and the ability to link patient diagnosis with procedural codes.

DUTIES (KEY RESULT AREAS/OUTPUTS)ASSIST VARIOUS INSTITUTIONS WITH CLEARING OF EXTERNALLY FUNDED REVENUE BACK LOGS RELATED TO ICD-10 CODE ASSIGNMENT, UPFS ASSIGNMENT AND THE MANAGEMENT OF PMB CONDITIONS. ASSIST VARIOUS HOSPITAL FEES DEPARTMENTS WITH FOLLOW-UP OF OUTSTANDING MEDICAL SCHEME AND STATE DEPARTMENT BALANCES AND ACCOUNT QUERIES. CONDUCT CLINICAL AUDITS OF PATIENT ACCOUNTS TO ENSURE ACCURACY OF INVOICES FOR SUBMISSION TO MEDICAL AIDS AND STATE DEPARTMENTS. PERFORM OPERATIONAL CASE MANAGEMENT FUNCTIONS AT VARIOUS INSTITUTIONS INCLUSIVE OF PRE-AUTHORISATION AND CLINICAL REVIEW TO ENSURE COMPLIANCE WITH CASE MANAGEMENT POLICIES AND PROCEDURES. ASSIST WITH EDI REJECTIONS TO ENSURE TIMEOUS SUBMISSION OF MEDICAL SCHEME INVOICES. PROVIDE QUOTATIONS TO H2, H3 AND FOREIGN PATIENTS. ASSIST WITH THE IMPLEMENTATION OF DEPARTMENTAL CASE MANAGEMENT POLICIES AND PROCEDURES BY PROVIDING ONSITE SKILLS DEVELOPMENT AND TRAINING OF RELEVANT ROLE PLAYERS IN MATTERS RELATING TO CASE MANAGEMENT. SUPERVISION AND DEVELOPMENT OF STAFF TO ENSURE FULLY FUNCTIONAL EFFECTIVE STAFF ABLE TO MEET PERFORMANCE TARGETS.

Duties (key result areas/outputs)Assist various institutions with clearing of externally funded revenue back logs related to ICD-10 code assignment, UPFS assignment and the management of PMB conditions. Assist various Hospital Fees Departments with follow-up of outstanding medical scheme and state department balances and account queries. Conduct clinical audits of patient accounts to ensure accuracy of invoices for submission to medical aids and state departments. Perform operational Case Management functions at various institutions inclusive of pre-authorisation and clinical review to ensure compliance with Case Management policies and procedures. Assist with EDI rejections to ensure timeous submission of medical scheme invoices. Provide quotations to H2, H3 and Foreign patients. Assist with the implementation of departmental case management policies and procedures by providing onsite skills development and training of relevant role players in matters relating to Case management. Supervision and development of staff to ensure fully functional effective staff able to meet performance targets.

ENQUIRIES

Ms L Ismail, tel. no. 069 245 5927

NOTE

This post will not be linked to any of the Occupational Specific Dispensations.

INHERENT REQUIREMENTS OF THE JOB

Willingness to travel and spend long periods away from the office. A valid Code 08 Driver’s Licence.

MINIMUM EDUCATIONAL QUALIFICATION

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

COMPETENCIES (KNOWLEDGE/SKILLS)

Good knowledge of the Uniform Patient Fees Schedule (UPFS)and or other tariff structures, Managed Health Care or Hospital Information Systems and EDI (Electronic Data Interchange). Knowledge of the Medical Schemes Act 131 of 1998 and the application of Prescribed Minimum Benefit (PMB) legislation i.e. the Chronic Disease List (CDL) and Diagnostic Treatment Pairs (DTP). Ability to work with Excel spread sheets, Microsoft Word and web-based programs (medical aids).

NOTICE TO ALL

Candidates must comply with the advertised appointment requirements of the post by the closing date and time of the advert.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. All shortlisted candidates, including SMS, shall undertake two pre-entry assessments. One will be a practical exercise to determine the candidate’s suitability based on the post’s technical and generic requirements, and the other will be an integrity (ethical conduct) assessment.

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 etc. Failure to adhere to the aforementioned may lead to his/her application being disqualified and not further considered.