Clinical Case Manager (Re-Advertisement) at Mpumalanga Department of Health

Requirements

• Senior Certificate / Grade 12 qualification plus Basic qualification accredited with the SANC in terms of Government Notice R425 (i.e. Diploma / Degree in General Nursing) or equivalent qualification that allows registration with the SANC as Professional Nurse and Midwifery (2026), a post-basic nursing qualification, with a duration of at least 1 year, accredited with the SANC in terms of Government Notice R212 specialty in ICU / Critical Care Science will be an added advantage. Minimum of four (4) years appropriate /recognizable experience in nursing after registration as a Professional Nurse with the SANC. NB: Non OSD posts. Ability to function independently and to prioritize work.

Duties

• Identify and select externally funded patients for case management intervention Perform Case Management functions, i.e. obtaining pre-authorisation for emergency admissions, verify benefits with medical schemes and send clinical updates and assist with the implementation of Case Management policies, protocols and procedures. Daily ward rounds to identify billable services done on RAF, M/A, SAPS, PCS, IOD, DOJ, H3. Liaise with the various role players e.g. clinicians and medical scheme case managers to monitor utilisation while in hospital. Monitor ICD-10 coding and other clinical information to prevent rejections by funders. Assist in Revenue office with ICD-10 coding accuracy before submitting a claim, provide most appropriate procedure codes. Dissemination of information. Do clinical statistics monthly of the cases managed, ICD10 codes used, medical schemes, authorizations obtained, updates done and clinical rejections monitored.