Case Manager – Private Hospital (Durban)

About the role

The Private Hospital in Glenwood, Durban seeks an experienced Case Manager to oversee patient admissions, ensure appropriate level of care, and manage financial risk through accurate clinical coding and liaison with medical aid providers.

Key responsibilities

• Apply clinical knowledge to justify patient hospitalisation, length of stay, and level of care.
• Monitor and act on medical aid benefit risks related to hospitalisation.
• Perform precise ICD‑10 and CPT coding for all hospital events.
• Communicate promptly and effectively with medical aid organisations to obtain authorisations and justify billing.
• Review authorisation approvals, mitigate financial risk, and release cases for billing.
• Liaise with internal and external stakeholders regarding patient treatment plans.
• Ensure compliance with NHN Managed Health Care rules and relevant legislative acts.

Required profile

• Formal qualification in Case Management.
• Experience in case management within a hospital setting.
• Familiarity with medical aid processes and hospital billing cycles.
• Strong attention to detail and ability to work under tight deadlines.

Required skills

• ICD‑10 coding
• CPT coding
• Clinic Manager software proficiency
• Microsoft Office suite