Administrative Case Manager, Pretoria

The purpose of this role is to coordinate patient admissions, manage medical aid authorisations, and ensure accurate reporting and compliance to optimise patient flow and length of stay within rehabilitation hospitals.

CRITICAL OUTPUTS

Managing and following up on medical aid authorisations to ensure continuity of patient care

Coordinating patient admissions and supporting optimal patient flow and length of stay

Submitting accurate and timeous reports (initial, weekly, and final) to medical aid funders

Maintaining accurate ICD-10 coding and ensuring alignment with clinical information

Monitoring patient data, authorisations, and system inputs daily for accuracy

Supporting hospital case managers and participating in multidisciplinary team (MDT) processes

Resolving authorisation challenges and escalating where required

Ensuring compliance with governance, audit, and funding requirements

Managing PMB registrations and handling account-related queries

Maintaining accurate and audit-ready documentation

REQUIREMENTS

Relevant nursing qualification

Registered with SANC as a Registered Nurse / Enrolled Nurse

Experience in hospital case management or medical aid authorisations

Knowledge of ICD-10 coding and case management processes

Understanding of medical aid funding requirements and reporting timelines

Proficiency in MS Office and hospital systems

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