Case Manager

Overview

Case Manager needed at Western Cape Health Head Office to assist institutions with ICD-10 code assignment and medical scheme revenue follow-up.

Requirements

• Minimum educational qualification: An Appropriate three-year health related National Diploma/Degree or equivalent registrable with the Health Professions Council of South Africa (HPCSA) or South African Nursing Council (SANC).
• Experience: Appropriate experience in Case Management/Medical Aid Environment or Revenue Generation.
• Appropriate experience in ICD-10 Code assignment and the ability to link patient diagnosis with procedural codes.
• Inherent requirements: Willingness to travel and spend long periods away from the office.
• A valid Code 08 Driver’s Licence.
• Competencies (knowledge/skills): Good knowledge of the Uniform Patient Fees Schedule (UPFS)and or other tariff structures, Managed Health Care or Hospital Information Systems and EDI (Electronic Data Interchange).
• Knowledge of the Medical Schemes Act 131 of 1998 and the application of Prescribed Minimum Benefit (PMB) legislation i.e. the Chronic Disease List (CDL) and Diagnostic Treatment Pairs (DTP).
• Ability to work with Excel spread sheets, Microsoft Word and web-based programs (medical aids).

Duties

• Assist various institutions with clearing of externally funded revenue back logs related to ICD-10 code assignment, UPFS assignment and the management of PMB conditions.
• Assist various Hospital Fees Departments with follow-up of outstanding medical scheme and state department balances and account queries.
• Conduct clinical audits of patient accounts to ensure accuracy of invoices for submission to medical aids and state departments.
• Perform operational Case Management functions at various institutions inclusive of pre- authorisation and clinical review to ensure compliance with Case Management policies and procedures.
• Assist with EDI rejections to ensure timeous submission of medical scheme invoices.
• Provide quotations to H2, H3 and Foreign patients.
• Assist with the implementation of departmental case management policies and procedures by providing onsite skills development and training of relevant role players in matters relating to Case management.
• Supervision and development of staff to ensure fully functional effective staff able to meet performance targets.

How to apply

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

Enquiries: Ms L Ismail at (069) 245-5927

Notes

No payment of any kind is required when applying for this post. This post will not be linked to any of the Occupational Specific Dispensations. 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