MAIN PURPOSE OF JOB

• To support the hospital in the absence of hospital Case Managers and to facilitate the communication process between all role players by providing accurate and timeous clinical information to minimise the financial risk for the organisation; and to support efficient and effective hospital cash conversion

KEY RESPONSIBILITY AREAS

• Minimise financial risk by effectively managing patient stay
• Ensure compliance to case management procedures, contracts and legal aspects by utilising available resources and systems
• Ensure correct and timeous finalisation of cases, and consistently and timeously communicate with Funders to facilitate reimbursement of claims

REQUIRED EDUCATION

ESSENTIAL EDUCATION

• Nursing qualification

DESIRED EDUCATION

• Registered Nurse / Professional Nurse

REQUIRED EXPERIENCE

ESSENTIAL MINIMUM EXPERIENCE

• 3 – 5 years in a nursing role

DESIRED EXPERIENCE

• Experience in Theatre and/ or ICU
• Medical aid background
• Experience in the private healthcare environment

REQUIRED JOB SKILLS AND KNOWLEDGE

• Anatomy; physiology and terminology
• Application and validation of clinical codes (Level 3 coding)
• Authorisation and motivation of Level of Care; Length of Stay; Short Payments etc.
• B2B EMS (Electronic message system: check status of authorisations and use for trouble-shooting)
• Computer literacy (e.g. Outlook and intranet applications)
• Daily Workflow, Managing deviances, Coding, and Case Management processes
• Funder Contracts; Medical aid requirements/narrations
• Patient Administration policies and procedures (Patient Confidentiality, Visitation of external case managers, etc.)
• Proficient all relevant Patient Admin systems and programs
• Relevant aspects of applicable statutory acts (e.g. Consumer Protection Act; PMB, etc.)
• Scientific Nursing Processes and associated procedures

Closing date: 12/01/2026