Clinical Case Manager

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. Leadership and sound interpersonal skills, problem solving and decision- making skills. Good supervisory and teaching skills. Good knowledge of the Uniform Patient Fees Schedule (UPFS), Knowledge of the Medical Schemes Act 131 of 1998 i.e. the Chronic Disease List (CDL) and Diagnostic Treatment Pairs (DTP) and the application of Prescribed Minimum Benefit (PMB) legislation. Experience in ICD-10 Code assignment and the ability to link patient diagnosis with procedure codes will be an advantage.

Key Responsibilities

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.

How to Apply

Enquiries

Mr. Emmanuel Makokoropo Tel No: (013) 766 3384 / Ms. Gugu Nkosi Tel No: (013) 766 3103 / Ms. Nomsa Maphanga Tel No: (013) 766 3207 / Ms. Sebenzile Mthisi Tel No: (013) 766 3339, Mr. Mxolisi Maseko Tel No: (013) 766 3351, Mr. Samson Nyoni Tel No: (013) 766 3087 and IT related queries: Help desk Tel No: (013) 766 3018.