Hospital Case Manager – Medical Group

About the role

The Hospital Case Manager will plan, coordinate and execute case management activities at a hospital level. Using clinical knowledge, the incumbent will minimise financial risk and ensure accurate billing through precise coding of patient care.

Key responsibilities

• Liaise with reception for authorisations and ensure compliance with case‑management procedures.
• Perform clinical coding in line with CHG standards, delivering accurate diagnostic and procedural codes for all patient records.
• Communicate promptly with funders (medical aids, COID, government, RAF, DOL, etc.) and provide required clinical information to update length of stay, level of care, formulary utilisation, assistive devices, and procedural interventions.
• Consult daily with healthcare providers to maintain patients’ clinical status and meet funder requirements throughout hospitalisation.
• Manage patient accounts to facilitate timely reimbursement and minimise financial risk.
• Finalise cases within target timelines (3 days WIP, discharged not yet billed) and follow escalation processes for payment declines.

Required profile

• Relevant nursing qualification or equivalent.
• 3–5 years experience as a hospital case manager.
• Experience with billing and coding processes in a medical environment.

Required skills

• ICD coding proficiency.
• IDC coding knowledge.
• CPO coding certification.
• Clinical coding expertise.