Clinical Case Manager – Bethal Hospital – Department Of Health

About the Role

The Department of Health is looking for a dedicated Clinical Case Manager to join the team at Bethal Hospital, located in the Gert Sibande District of Mpumalanga. This role is vital in ensuring that patients receive the necessary case management interventions, which directly impact their health outcomes and overall experience in the healthcare system. By actively engaging with various stakeholders, including clinicians and medical scheme case managers, you will play a crucial part in monitoring patient care and ensuring that services are utilized effectively while upholding the standards of public service in South Africa.

As a Clinical Case Manager, your work will not only contribute to the efficient operation of the hospital but also enhance the quality of care provided to the community. You will be at the forefront of managing cases that require meticulous attention to detail, especially in liaising with medical schemes and ensuring accurate coding of diagnoses. This is an opportunity to make a meaningful difference in the lives of patients by advocating for their needs and facilitating their access to essential health services.

About the Department

The Department of Health is committed to promoting and ensuring the health and wellbeing of all South Africans. Its mission encompasses a wide range of responsibilities, including the provision of healthcare services, the implementation of health policies, and the management of healthcare resources. Working in this department means being part of a larger effort to improve public health outcomes and foster a healthier society. Your role as a Clinical Case Manager will align with these objectives, allowing you to contribute to impactful initiatives that benefit the community.

What You’ll Do

• Identify and select patients for case management intervention based on specific criteria.
• Perform essential case management tasks, including obtaining pre-authorization for emergency admissions and verifying benefits with medical schemes.
• Conduct daily ward rounds to identify billable services and ensure accurate documentation.
• Liaise with various role players, such as clinicians and medical scheme case managers, to monitor the utilization of services during hospital stays.
• Oversee the accuracy of ICD-10 coding and clinical information to prevent claim rejections.
• Assist the revenue office in ensuring correct coding before submitting claims.
• Compile monthly clinical statistics on managed cases, including ICD-10 codes and authorizations obtained.

What You’ll Need

• Senior Certificate / Grade 12 qualification.
• Basic qualification accredited with the SANC as a Professional Nurse and Midwife (e.g. Diploma/Degree in General Nursing).
• A post-basic nursing qualification in ICU/Critical Care Science is advantageous.
• A minimum of four years of nursing experience after registration with the SANC.
• Strong leadership, problem-solving, and interpersonal skills.
• Knowledge of the Uniform Patient Fees Schedule and Medical Schemes Act 131 of 1998.
• Experience in ICD-10 Code assignment and linking patient diagnoses with procedure codes is a plus.

How to Apply

Please refer to the application instructions below.