Clinical Case Manager – Durban

About the role

The medical practice in Berea, near St Augustine's Hospital, is seeking an experienced Clinical Case Manager to join its professional team. The role combines clinical expertise with financial risk mitigation, ensuring accurate coding and appropriate justification for patient hospitalisation.

Key responsibilities

• Apply clinical knowledge to justify patient admission, length of stay, and level of care.
• Monitor and act on risks related to medical aid benefits and hospitalisation.
• Perform accurate, specific, and comprehensive clinical coding.
• Communicate promptly and effectively with medical aid providers.
• Review authorisations, mitigate financial risk, and release cases for billing.
• Liaise with internal and external stakeholders regarding patient treatment.
• Adhere to NHN Managed Health Care rules of engagement and relevant legislative acts.

Required profile

• Case Management qualification (preferred).
• Proven experience in case management.
• Knowledge of ICD‑10 and CPT coding systems.
• Familiarity with clinic management software is advantageous.

Required skills

• ICD‑10 coding
• CPT coding
• Clinic Manager software
• Proficiency in Microsoft Office products