Case Manager

About the role

The Case Manager will provide hospital utilisation management, education and clinically based activities to coordinate care between the medical scheme, members, providers and the community. This position supports members throughout admission, treatment and discharge, ensuring compliance with clinical guidelines.

Key responsibilities

• Verify eligibility of cover according to medical scheme rules and membership files.
• Facilitate admission to appropriate facilities and assess co‑morbid conditions.
• Communicate clinical status, level of care, length of stay and value to hospitals.
• Collaborate with attending physicians, medical advisors and allied health professionals to develop and execute care plans.
• Arrange transfers to alternative facilities when ongoing care is required.
• Refer patients to disease management programmes during hospital stays.
• Update computer systems with clinical and demographic details, visit high‑cost members in hospital, and present cases at clinical meetings.
• Prepare reports, case summaries and complete special projects as needed.

Required profile

• A clinical degree or diploma recognised by the HPCSA or the South African Nursing Council.
• Additional clinical qualification and/or experience in a related field is preferred.

Required skills