Case Manager (Permanent position)

A job opportunity exists for the right candidate in Western Cape

Employment Type:
Permanent

Reference No:
MHS496/2026

Location:
Khayelitsha District Hospital, Chief Directorate: Metro Health Services

REMUNERATION

R 413 001 per annum - R 486 501 per annum Annual salary plus service benefits (13th cheque, employer's contribution to the pension fund, housing and medical aid allowance).

STARTING DATE

14 Aug 2026

CLOSING DATE

• PLEASE NOTE:

28 Aug 2026, 5:00 pm

EMPLOYMENT EQUITY

The Department of Health and Wellness is guided by the principles of Employment Equity. Candidates with disabilities are encouraged to apply and an indication in the regard will be appreciated.

Note: No payment of any kind is required when applying for any of the positions advertised by the Western Cape Government.

EXPERIENCE

Appropriate experience in the Managed Health Care sector i.e. Case Management or Medical Aid environment and Revenue Generation.

MINIMUM EDUCATIONAL QUALIFICATION

Appropriate three-year health related National Diploma/ Degree registrable with the Health Professions Council of South Africa (HPCSA) or South African Nursing Council (SANC).

ENQUIRIES

Enquiries: Ms. C.Swartz Tel. no. (021) 360 4281

COMPETENCIES (KNOWLEDGE/SKILLS)

Knowledge of the Medical Schemes Act 131 of 1998, regulations and annexures as amended. Knowledge of prescribed minimum benefits i.e. the chronic disease list and diagnostic treatment pairs. Basic knowledge of the uniform patient fees schedule and patient billing. Knowledge of and experience in ICD 10 Codes assignment and the ability to link patient diagnosis with procedure codes. Knowledge of Clinicom and EDI (Electronic Data Interchange). Ability to work with Excel spread sheets, Microsoft Word and web based programs (medical aids).Excellent communication, conflict management, interpersonal and leadership skills. Excellent written and verbal communication in at least two of the three official languages of the western cape.

DUTIES (KEY RESULT AREAS/OUTPUTS)PERFORM CASE MANAGEMENT FUNCTIONS, I.E. OBTAINING PRE-AUTHORIZATION AND VERIFICATION OF BENEFITS AS NEEDED, CONCURRENT, RETROSPECTIVE REVIEW, DISCHARGE PLANNING AND PROVIDE QUOTATIONS TO H2, H3 AND FOREIGN PATIENTS. ASSIST WITH MEDIKREDIT EDI REJECTION REPORTS AND ENSURE CORRECTIONS ARE COMPLETED TIMEOUSLY AND RESUBMITTED TO MEDIKREDIT. LIAISE WITH THE VARIOUS ROLE-PLAYERS E.G. CLINICIANS, MANAGED CARE ORGANIZATIONS AND MEDICAL SCHEME CASE MANAGERS TO MONITOR UTILISATION AND UPDATE PATIENT’S CLINICAL INFORMATION WHILE IN HOSPITAL. MANAGE AND IMPLEMENT CASE MANAGEMENT POLICIES, PROTOCOLS AND PROCEDURES IN THE HOSPITAL. CONDUCT CLINICAL AUDITS OF PATIENT ACCOUNTS INCLUSIVE OF MEDICAL AIDS, STATE DEPARTMENTS E.G. RAF AND COIDA TO ENSURE ACCURACY OF INVOICES WITH REGARD TO ICD 10 CODES, UPFS PROCEDURE CODES AND RESOURCE UTILIZATION. MANAGE AND SUPERVISE CASE MANAGEMENT AND REVENUE DEPARTMENTS.

Duties (key result areas/outputs)Perform Case Management functions, i.e. obtaining pre-authorization and verification of benefits as needed, concurrent, retrospective review, discharge planning and provide quotations to H2, H3 and foreign patients. Assist with Medikredit EDI rejection reports and ensure corrections are completed timeously and resubmitted to Medikredit. Liaise with the various role-players e.g. clinicians, managed care organizations and medical scheme case managers to monitor utilisation and update patient’s clinical information while in hospital. Manage and implement case management policies, protocols and procedures in the hospital. Conduct clinical audits of patient accounts inclusive of medical aids, state departments e.g. RAF and COIDA to ensure accuracy of invoices with regard to ICD 10 codes, UPFS procedure codes and resource utilization. Manage and supervise Case Management and Revenue departments.

NOTICE TO ALL

Candidates must comply with the advertised appointment requirements of the post by the closing date and time of the advert.Candidates may be subjected to a competency test. No payment of any kind is required when applying for this post. As directed by the Department of Public Service and Administration, applicants must note that further checks will be conducted once they are shortlisted and that their appointment is subject to positive outcomes on these checks, which include security clearance, qualification verification, criminal records and previous employment. All shortlisted candidates, including SMS, shall undertake two pre-entry assessments. One will be a practical exercise to determine the candidate’s suitability based on the post’s technical and generic requirements, and the other will be an integrity (ethical conduct) assessment.

It will be expected of shortlisted candidates to be:
available at the venue on the time and date as determined by the Department and

bring along recently (not older than 6 months) certified copies of your Identity Document (ID), driver’s license (if applicable for the post), qualification and/or proof of registration at relevant statutory body etc. Failure to adhere to the aforementioned may lead to his/her application being disqualified and not further considered.