Senior Case Manager x 2- Lenmed Head Office at Lenmed Private Hospitals

Main Focus Areas

• The incumbent will be responsible for providing on-site and remote support during peak periods, staff shortages, or operational challenges, ensuring continuity and stability of patient services. for delivering targeted business deployment and operational support across all Lenmed hospitals, with a specific focus on stabilising case management operations, enhancing capacity, and driving sustained performance improvement in high-demand or underperforming environments. This role ensures the consistent delivery of efficient, standardised case management processes, underpinned by robust quality assurance, adherence to policies and procedures, regulatory compliance, and sound financial governance. In addition, a focused operational case management component is retained to ensure continuity of service, maintain critical clinical and funding insights, and enable the proactive identification and resolution of systemic inefficiencies.

Key Performance Areas: (include but are not limited to)
Case Management processes

• Provide hands-on operational case management support within assigned facilities.
• Assess operational gaps, risks, and priority interventions upon deployment.
• Stabilise and optimise case management processes in line with SOPs and funder requirements.
• Coordinate multidisciplinary care, including ward rounds and collaboration with clinical and administrative teams.
• Manage high-risk and high-cost cases to ensure appropriate resource utilisation.
• Ensure timely clinical updates and compliance with turnaround times.
• Oversee authorisation processes and manage escalations in line with funder requirements.
• Monitor PAAS scoring and levels of care to ensure clinical appropriateness.
• Analyse trends, rejections, and inefficiencies, implementing corrective actions.
• Prepare detailed deployment reports with key findings and improvements.

Clinical Coding

• Ensure accurate ICD-10 and CPT/CCSA coding in line with national and funder requirements.
• Review clinical documentation and collaborate with clinicians to ensure coding accuracy.
• Conduct coding audits and address discrepancies.
• Support revenue cycle management by reducing claim rejections and financial leakage.
• Manage coding-related queries and maintain compliance with evolving standards.

Financial & DNYB Management

• Manage financial risk across the patient journey, including pre-admissions and confirmations.
• Monitor authorisations and proactively address funding risks.
• Review theatre lists to ensure financial readiness prior to admission.
• Manage DNYB to achieve ≤5-day targets.
• Analyse P/L and ARM accounts to optimise revenue and mitigate risk. 

Stakeholder Management - Build and maintain stakeholder relationships

• Establish and maintain strategic relationships with internal and external stakeholders across multiple hospital sites, fostering collaboration and alignment with organisational and patient service objectives.
• Facilitate effective communication and coordination between admissions, case management, nursing, finance, and clinical teams to ensure seamless patient journeys and continuity of care.
• Ensure effective management and resolution of queries and complaints, applying sound judgement and service excellence principles to achieve timely, patient-centered outcomes.
• Engage with treating doctors regarding financial risks and funding limitations to support informed decision-making.
• Liaise with funders to resolve complex authorisation, case management and coding queries and matters.

Post Requirements: (include but are not limited to)

• B Degree Nursing Qualification or equivalent NQF level 6.
• Relevant clinical coding certification (advantageous)
• Current registration with the South African Nursing Council (SANC) or a professional body
• Proven experience in case management and clinical coding within a hospital environment
• Strong knowledge of medical aid rules and hospital billing processes
• Experience in managing financial risk and DNYB
• Computer literacy (Microsoft Office); SAP/Kronos advantageous5 years case management experience in a multi-disciplinary hospital
• Strong understanding of medical aid rules and funding protocols
• Case management and revenue cycle processes
• Clinical coding (ICD-10, CPT/CCSA)
• Advanced ICD-10 Qualification
• Extensive travel is required as part of this role. Candidates must be willing and able to travel frequently,

Deadline:4th August,2026