Non-Clinical Case Manager (Kimberly)

About the role

The Case Manager will use clinical knowledge to mitigate financial risk by ensuring accurate coding of hospital events and communicating with funders to justify level of care and length of stay. The position is based in Sunningdale, Cape Town and supports the health‑management team.

Key responsibilities

• Apply clinical knowledge to justify patient hospitalisation regarding treatment, length of stay and level of care.
• Monitor and act on risks related to medical aid benefits and hospitalisation.
• Ensure accurate, specific and comprehensive clinical coding.
• Communicate timely and effectively with medical aids and follow up on authorisations.
• Review authorisation aspects, mitigate financial risk and release cases for billing.
• Liaise with internal and external stakeholders regarding patient treatment.
• Adhere to NHN Managed Health Care rules and comply with relevant legislation.

Required profile

• Proven case management experience.
• Qualification or experience in ICD-10 and CPT coding.
• Experience with SAP IS-H (advantageous).
• Proficiency in Microsoft Office applications.

Required skills

• ICD-10 coding
• CPT coding
• SAP IS-H
• Microsoft Office