Hire Resolve's client is seeking a skilled and detail-oriented Hospital Case Manager to join their healthcare team in Mthatha, Eastern Cape . The successful candidate will be responsible for coordinating patient care, ensuring accurate medical coding, and optimizing hospital reimbursements while maintaining high-quality patient care standards.

Key Responsibilities

Patient Case Management: Assess and manage patient cases to ensure efficient hospital care and appropriate medical aid approvals.
Authorization & Pre-Approvals: Obtain authorization for hospital admissions and liaise with medical aids to ensure timely approvals.
Clinical Coding: Ensure accurate ICD-10 and CPT coding for billing purposes.
Utilization Review: Monitor length of stay, treatment plans, and resource utilization to optimize hospital efficiency.
Collaboration: Work closely with doctors, nurses, and medical aid schemes to facilitate smooth patient care processes.
Compliance & Reporting: Maintain documentation and ensure compliance with medical aid policies, hospital protocols, and legal standards.
Patient Advocacy: Support patients by explaining medical aid benefits and assisting with any coverage issues.

Requirements

Qualification: Diploma/Degree in Nursing or a related healthcare field.
Clinical Coding Certification (advantageous).
Experience: At least 23 years of experience in hospital case management or a similar role.
Knowledge of ICD-10 & CPT Coding.
Strong understanding of medical aid processes and hospital billing systems.
Excellent communication and negotiation skills.
Ability to work in a fast-paced hospital environment.

If youre looking for an opportunity to advance your career in hospital case management , apply today!

If you meet the above requirements and want to make a career-changing move, apply today by emailing your CV to *****@*****.co.za or visit our website:

You can also connect with Rachel van Dyk on LinkedIn or *****@*****.co.za

Please note that correspondence will only be conducted with shortlisted candidates for this position. Should you not hear from us within 3 days, please consider your application unsuccessful.