Case Manager

Overview

Case Manager needed at Khayelitsha District Hospital to perform pre-authorisation, benefit verification and discharge planning functions.

Requirements

• Minimum educational qualification: Appropriate three-year health related National Diploma/ Degree registrable with the Health Professions Council of South Africa (HPCSA) or South African Nursing Council (SANC).
• Experience: Appropriate experience in the Managed Health Care sector i.e.
• Case Management or Medical Aid environment and Revenue Generation.
• Competencies (knowledge/skills): Knowledge of the Medical Schemes Act 131 of 1998, regulations and annexures as amended.
• Knowledge of prescribed minimum benefits i.e. the chronic disease list and diagnostic treatment pairs.
• Basic knowledge of the uniform patient fees schedule and patient billing.
• Knowledge of and experience in ICD 10 Codes assignment and the ability to link patient diagnosis with procedure codes.
• Knowledge of Clinicom and EDI (Electronic Data Interchange).
• Ability to work with Excel spread sheets, Microsoft Word and web based programs (medical aids).
• Excellent communication, conflict management, interpersonal and leadership skills.
• Excellent written and verbal communication in at least two of the three official languages of the western cape.

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 Medikredit EDI rejection reports and ensure corrections are completed timeously and resubmitted to Medikredit.
• Liaise with the various role-players e.g. clinicians, managed care organizations and medical scheme case managers to monitor utilisation 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 with regard to ICD 10 codes, UPFS procedure codes and resource utilization.
• Manage and supervise Case Management and Revenue departments.

How to apply

Applications are submitted online via www.westerncape.gov.za/health-jobs (click “online applications”).

Enquiries: Ms C.Swartz Tel No: (021) 360-4281

Notes

No payment of any kind is required when applying for this post. It will be expected of candidates to be available for selection interviews on a date, time and place as determined by the Department. Kindly note that excess personnel will receive preference. All shortlisted candidates, including the SMS, shall undertake two pre-entry assessments. One will be a practical exercise to determine a candidate’s suitability based on the post’s technical and generic requirements and the other must be an integrity (ethical conduct) assessment. ERRATUM: Kindly note that the advert for the Post 28/215: Assistant Director: Expenditure Analysis and Management Reporting, Salary R487 197 per annum, Centre: Head Office (Cape Town) advertised in the Public Service Vacancy 28 dated 07 August 2026 with Ref No: 28/215. Kindly note that the post has been cancelled. OTHER POSTS