SPH Case Manager

About the role

The SPH Case Manager uses clinical knowledge to mitigate financial risk by ensuring accurate coding of hospital events and communicating with funders to justify the level of care and length of stay. This position is based at Shifa Private Hospital in Durban.

Key responsibilities

• Apply clinical expertise to justify patient hospitalization, including 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 of all cases.
• Communicate promptly and effectively with medical‑aid providers and follow up on queries.
• Review authorisation aspects, mitigate financial risk, and release cases for billing.
• Liaise with internal and external stakeholders regarding patient treatment plans.
• Adhere to Managed Health Care rules of engagement and comply with all relevant legislation.

Required profile

• B Degree/Diploma in Nursing and/or a Case Management qualification.
• Diverse clinical nursing experience.
• Proven case management experience.
• ICD‑10 / CPT coding qualification or demonstrable experience.
• Experience with SAP IS‑H (advantageous).
• Proficiency in Microsoft Office applications.

Required skills

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