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)

• 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.
• Ensure accurate ICD-10 and CPT/CCSA coding in line with national standards and funder requirements.
• Review clinical documentation and collaborate with clinicians to ensure accuracy and completeness.
• Conduct coding audits and address discrepancies to minimise financial risk.
• Manage coding-related rejections and queries, ensuring timely resolution.
• Maintain compliance with regulatory, ethical, and confidentiality standards.
• Manage financial risk across the patient journey, including pre-admissions and confirmations.
• Oversee authorisations and proactively address funding risks.
• Monitor theatre lists to ensure financial readiness prior to admission.
• Manage DNYB in line with targets (≤ 5 days) and optimise revenue cycle processes.
• Analyse financial trends, including P/L and ARM accounts, to drive improvements
• Build and maintain strong relationships with internal and external stakeholders across multiple facilities.
• Facilitate collaboration between clinical, nursing, finance, and administrative teams.
• Engage with treating doctors and funders to resolve complex clinical and financial queries.
• Ensure effective resolution of escalations and complaints.
• Strong expertise in case management, clinical coding, and hospital revenue cycle processed.
• Ability to work in high-pressure and complex environments.

Post Requirements: (include but are not limited to)

• B Degree Nursing Qualification or equivalent NQF level 6.
• Current registration with the South African Nursing Council (SANC) or a professional body.
• 5 years case management experience in a multi-disciplinary hospital
• Strong understanding of: Medical aid rules and funding protocols, Case management , revenue cycle processes  and Clinical coding (ICD-10, CPT/CCSA).
• Proficiency in Microsoft Office and hospital systems (e.g., SAP IS-H)
• Advanced ICD-10 Qualification
• CPT/CCSA Coding experience