Case Manager

Melomed Private Hospitals SA

2026/06/05   Northern Suburbs (Cape)

Job Ref #: MB-CASEMAN-000123
Industry: Pharmaceutical And Medical/Healthcare
Job Type: Permanent
Positions Available: 1
A hospital case manager is a healthcare professional—usually a registered nurse or social worker—who coordinates a patient’s journey from admission to discharge. They act as a vital bridge between patients, medical staff, and funders (medical aids) to ensure high-quality care, appropriate resource use, and smooth transitions home
Job Description
  • Assess patient conditions and needs to develop appropriate care plans
  • Interact with patients and medical aid schemes
  • Resolve patient and medical aid scheme queries
  • Update all information timeously and accurately
  • CPT and ICD coding
  • Obtain doctors letters, motivations, and justifications in all appropriate cases under managed care of where medical aids request them from their hospitals as part of their assessing process
  • Monitor patient admissions and identify those who have limitations, restrictions, place by their managed care/ medical aid structures e.g. length of stay, cost restrictions, fixed fees, per diem and other limiting fees or drugs and/ or formularies
  • Maintain a control system that ensures the systematic monitoring of managed care patients
  • Handling patient queries
  • Update hospital information
Job Requirements
  • Qualified Registered Nurse
  • A qualified EN with relevant experience would be considered
  • Both need to registered with SANC and proof of indemnity cover
  • Minimum 3 years nursing experience in a multidisciplinary hospital.
  • Experience and exposure in Theatre and/or ICU would be advantageous
  • Hospital or Medical Aid scheme case management would be an advantage.
  • Experience in ICD 10 and CPT coding is essential
  • Knowledge of Prescribed Minimum Benefits (PMB) Scheme rules and policies
  • Excellent communication skills (written and spoken)
  • Excellent analytical and problem-solving skills
  • Excellent MS Office computer skills, i.e. Outlook, Word, Excel, Kronos, Clinic Manager, etc.
  • Attention to detail
  • Ability to cope well under pressure