Senior Case Manager – Hospital Group – Durban KZN Full Time

About the Job:

The incumbent will be responsible for providing on-site and remote support during peak periods, staff shortages and operational challenges, ensuring continuity and stability of patient services.

The role will provide targeted business deployment and operational support across all the hospital group’s hospitals in Durban, KwaZulu-Natal, with a specific focus on stabilising case management operations, enhancing operational capacity and driving sustained performance improvement within high-demand or underperforming environments.

The role is responsible for ensuring the consistent delivery of efficient and standardised case management processes, underpinned by robust quality assurance, adherence to organisational policies and procedures, regulatory compliance, and sound financial governance.

In addition, the role will retain a focused operational case management component to ensure continuity of service, maintain critical clinical and funding insights, and enable the proactive identification, escalation and resolution of systemic inefficiencies. The incumbent will work closely with hospital management, case management teams and relevant stakeholders to identify operational gaps, implement appropriate interventions and support

Requirements:

Minimum Required Education

• B Degree in Nursing (NQF 6) or equivalent
• Current SANC registration, or relevant allied health registration
• Advanced computer literacy and high accuracy in clinical and billing systems
• 3–5+ years acute hospital experience
• 3+ years in case management, managed care, or patient flow

Inherent Requirements

• Proven experience in case management and clinical coding within a hospital environment
• Strong knowledge of medical aid rules and hospital billing processes
• Experience in managing financial risk and DNYB
• Computer literacy (Microsoft Office); SAP/Kronos advantageous 5 year’s case management experience in a multi-disciplinary hospital
• Strong understanding of medical aid rules and funding protocols
• Case management and revenue cycle processes
• Clinical coding (ICD-10, CPT/CCSA)
• Advanced ICD-10 Qualification

Duties & Responsibilities:

• Provide on-site and remote operational support across the hospital group’s hospitals KwaZulu Natal during peak periods, staff shortages and operational challenges
• Provide targeted business deployment and case management support to facilities requiring additional operational intervention
• Rapidly assess case management operations upon deployment and identify gaps, risks and priority areas requiring immediate attention
• Stabilise and optimise case management processes in line with organisational policies, SOPs, funder requirements and regulatory standards
• Ensure continuity and stability of patient services during periods of increased operational demand
• Coordinate multidisciplinary care by facilitating daily ward rounds and effective collaboration between clinical, nursing and administrative teams
• Monitor PAAS scoring and appropriate levels of care to ensure clinical appropriateness and consistency
• Identify, prioritise and actively manage high-risk and high-cost cases
• Ensure timely and accurate clinical updates, including required turnaround times such as 8-hour updates, to support funding approvals and clinical decision-making
• Oversee and support authorisation processes, ensuring cases are clinically and financially justified
• Proactively manage funder escalations in accordance with relevant escalation matrices
• Support accurate and compliant clinical coding, ensuring alignment between clinical documentation, coding and billing requirements
• Maintain critical clinical and funding insights to support operational and financial decision-making
• Analyse case management trends, rejections, operational inefficiencies and systemic challenges, implementing corrective actions where required
• Drive sustained performance improvement by identifying opportunities to strengthen capacity, processes and team capability
• Promote standardised case management practices and ensure consistent implementation across facilities
• Facilitate effective communication with treating doctors, funders, hospital management and multidisciplinary teams
• Manage and resolve funder queries, high-risk cases and operational challenges proactively
• Strengthen team capability through coaching, guidance, knowledge sharing and promotion of best practices
• Drive compliance with clinical governance, quality assurance and regulatory requirements
• Support safe, effective and patient-centred care delivery
• Prepare and submit deployment reports outlining key findings, identified risks, interventions implemented, outcomes and performance improvements achieved

Should you meet the above requirements, we urge you to apply by forwarding your CV along with any supporting documents to tracy@glass-house.co.za