Professional Nurse (Case Manager)

Requirements :

• The applicant must be in possession of a Grade 12 Certificate and a Diploma in Nursing (R171) or Diploma in Nursing (R425), or an equivalent nursing qualification, with current registration with the South African Nursing Council (SANC) as a Professional Nurse.
• The applicant must have 3–5 years’ relevant clinical nursing experience and knowledge and understanding of applicable healthcare legislation, policies and regulatory frameworks, including the National Health Act, Public Finance Management Act (PFMA), Medical Schemes Act, Prescribed Minimum Benefits (PMB) Regulations, Uniform Patient Fee Schedule (UPFS) and relevant Department of Health policies and procedures. Knowledge of ICD-10 and procedure coding will be an added advantage.
• The applicant must be computer literate, with proficiency in Microsoft Office, particularly MS Word and MS Excel. The applicant must be a driven, accountable and customer-focused individual with good planning, organizing, coordination, communication and report-writing skills. Good interpersonal relations, customer service and training skills are essential, together with the ability to work independently, effectively within a multidisciplinary healthcare environment and under pressure.

Duties :

• Perform Case Management functions, i.e. obtaining pre-authorization and verification of benefits as needed, concurrent, retrospective review, discharge planning and provide quotations to H2, H3 and foreign patients.
• Assist with Medical Aid rejection reports and ensure corrections are completed timeously and resubmitted to Medical Aid. Liaise with the various role-players e.g. clinicians, managed care organizations and medical scheme case managers to monitor utilization and update patient’s clinical information while in hospital. Manage and implement case management policies, protocols and procedures in the hospital. Conduct clinical audits of patient accounts inclusive of medical aids, state departments e.g. RAF and COIDA to ensure accuracy of invoices about ICD 10 codes, UPFS procedure codes and resource utilization.
• Manage and supervise Case Management and Revenue departments. Manage performance and development of staff. Application of clinical knowledge in the risk management (financial and clinical) of patients in terms of Length of Stay (LOS), Level of Care (LOC), clinical updates, ICD 10 Coding, procedure coding and cost benefits available, identification of billable services, treatment care plans, chronic disease case management and discharge planning. Audit patient’s accounts, train hospital officials on the utilization of charge sheet, and keep electronic and physical records.

Closing Date : 07-10-2026