Case Manager (Temporary Position) City Hospital at Joint Medical Holdings

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.