Case Manager – Hospital Group (Kwa-Zulu Natal) Full Time

2025-07-01
Main Purpose of Job:

Ensure that the complete Case Management function is performed on a daily basis.

Application of policies for the operation within the Hospital Industry.

Ensuring adherence to all relevant statutes, statutory bodies, rules and regulations, disciplinary code, and staff employee manuals.

Requirements:

• A valid Grade 12 or Matric Equivalent Certificate
• Extensive case management background with ICU/ High Care experience
• Computer literacy essential
• Strong Administration skills
• Knowledge of Medical Aid Policies & Procedures
• Above average interpersonal and Communication Skills
• Absolute compliance with Confidentiality Policies & Procedures

Duties & Responsibilities:

• Check confirmations for L.O.S and L.O.C relative to each patient.
• Assess patient clinical reports for communication to Medical Aids.
• Process updates with Medical Aid for each patient.
• Intermediate/ Advanced competency of ICD 10 and CPT coding.
• Check all ICD, CPT Coding, and authorization numbers.
• Handle communication and queries with Medical Aid Case Managers.
• Assist Patients/Doctors with patients requiring step down facilities.
• Liaising with Doctors, Nursing Staff and Patients.
• Liaising with the Debtors Department regarding any queries.
• Release and submit claims timeously to medical aid via Medikredit.
• Release and submit accounts timeously.
• Constantly monitoring patient status.
• Constantly liaising with Medical Aids updating patient status.
• Effective communication with Patients, Doctors, Nursing Staff, Medical Aids etc.
• Ensure adequate record keeping.
• General administration duties.
• Ensure weekly case management queries are carried out