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Case Manager

Paardevlei

07 Jul 2025

Patient Services

The Case Manager will be responsible for the liaison between the patient and medical aids to secure payment for the hospital.

Responsibilities and Duties: 

  • Ensure all the relevant details on the Hospital Billing System are updated and accurate
  • Supply all details regarding patients’ history to Clinical partners
  • Monitor and control costs for Managed Care Organisation patients
  • Confirm the length of stay for all Managed Care Organisations patients
  • Accompany Managed Care Organisation Case Managers on ward rounds in the hospital
  • Assist with final authorisation of Managed Care patient files
  • Ensure correct coding for all Managed Care Organisation patients
  • Consult with the relevant service providers regarding the patient care treatment
  • Assist with the transfer of patients to the Rehab Hospital or step-down facilities
  • Liaise network of internal and external stakeholders to ensure that the managed care of patients is maintained
  • Work effectively and co-operatively with others to establish and maintain good, mutually beneficial working relationships

  • Grade 12 or equivalent NQF level 4 qualification
  • Diploma in Nursing or B Degree Nursing Qualification

  • Three or more years of experience in Private Healthcare
  • Experience in a Psychiatric or Mental Wellness facility is advantageous
  • SAP experience will be advantageous
  • Previous experience in stock management
  • ICD & CPT Coding would be advantageous

  • Understanding of the Mental Health Care Act, No. 17 of 2002 and the Regulations beneficial
  • SAP system Essential
  • Intermediate computer skills
  • Knowledge of Medical Aids