Case Manager - Durban (74977)

Job Description

• An established medical practice in Berea, Durban, is looking for an experienced Case Manager to join its friendly and professional team!
• This is an exciting opportunity for someone who enjoys working at the intersection of clinical care, medical aid liaison and healthcare administration. You'll play an important role in ensuring patients receive the appropriate level of care while helping to manage hospitalisation costs and minimise financial risk.

What will you be doing?

• You'll be at the heart of the case management process, using your clinical expertise, attention to detail and communication skills to keep everything running smoothly.

Your key responsibilities will include:

• Applying your clinical knowledge to assess and motivate appropriate hospitalisation, treatment plans, levels of care and length of stay.
• Monitoring medical aid benefits and identifying potential financial risks relating to hospitalisation.
• Ensuring accurate, detailed and comprehensive clinical coding.
• Communicating and following up with medical aids to secure appropriate authorisations.
• Reviewing approved authorisations, identifying potential shortfalls and ensuring cases are financially cleared before billing.
• Building and maintaining strong working relationships with internal and external healthcare stakeholders.
• Following NHN Managed Health Care rules of engagement.
• Ensuring compliance with all relevant healthcare legislation, regulations and industry requirements.

What are we looking for?

• We're looking for someone who brings both clinical understanding and a proactive, organised approach to case management.

Essential requirements:

• Previous experience in a Case Management role.
• Experience with ICD-10 and CPT coding.
• A Case Management qualification would be a definite advantage.
• Experience with Clinic Manager software would be beneficial.
• Good working knowledge of Microsoft Office applications.
• Excellent communication, organisational and administrative skills.
• Strong attention to detail and the ability to manage multiple cases effectively.