Senior Hospital Case Manager – Patient Care Coordination
Mediclinic vacancies
Available Locations:
Johannesburg, Gauteng
Job Description
Job Summary
Mediclinic is seeking a Senior Hospital Case Manager to lead end‑to‑end patient care coordination, discharge planning, and utilisation management across multidisciplinary teams. You will be the clinical–operational bridge who ensures every patient receives the right care, in the right place, at the right time, while optimising quality, safety, length of stay, and cost-effectiveness. You will mentor a team of case managers, shape care pathways, and partner closely with physicians, nursing leadership, payers, and community services to drive seamless patient journeys and measurable outcomes.
Key Responsibilities
- Care Coordination & Discharge Planning
- Lead complex discharge planning from admission through post‑acute transition (home health, rehab, LTAC, community services).
- Proactively identify barriers to discharge and escalate/resolution-manage with relevant stakeholders.
- Ensure comprehensive, patient-centred care plans are documented, communicated, and executed.
- Utilisation Management & Clinical Governance
- Perform admission, continued-stay, and level-of-care reviews using evidence-based criteria (e.g., InterQual/MCG).
- Reduce avoidable days, denials, and readmissions via proactive utilisation review and payer engagement.
- Track and report on LOS, ALOS vs. DRG, readmission, and denial trends; drive corrective action plans.
- Leadership & Mentorship
- Supervise, coach, and develop case managers and social workers; run daily huddles and multidisciplinary rounds.
- Standardise best practices, SOPs, and documentation quality across the case management function.
- Lead complex case conferences and ethics/family meetings when required.
- Stakeholder & Payer Collaboration
- Liaise with physicians, nursing, allied health, revenue cycle, coding, and insurers to align care and reimbursement.
- Manage complex authorisations, peer-to-peer reviews, and appeals.
- Quality, Safety & Compliance
- Ensure compliance with hospital policies, national regulations, and accreditation standards (e.g., JCIA/JCI/ISO as applicable).
- Contribute to quality improvement projects, pathway optimisation, and patient experience initiatives.
- Data, Reporting & Insights
- Produce dashboards/KPIs on throughput, bed management, and financial impact.
- Use data to anticipate risk, stratify patients, and prioritise interventions.
Required Skills and Qualifications
- Education:
- Bachelor’s degree in Nursing, Social Work, or Allied Health required.
- Master’s degree in Healthcare Administration, Nursing, Social Work, or related field preferred.
- Licensure/Certification (as applicable by country/region):
- Active professional license (RN, Social Worker, or equivalent).
- Preferred certifications: CCM (Certified Case Manager), ACM/ACMA, or equivalent case management/utilisation review credential.
- Core Competencies:
- Deep knowledge of acute care workflows, utilisation management criteria (InterQual/MCG), DRGs, and reimbursement methodologies.
- Advanced discharge planning and community resource navigation skills.
- Strong negotiation, conflict resolution, and advocacy abilities.
- Excellent clinical judgement with a systems-thinking mindset.
- Proficiency with EMR/EHR systems and case management tools; strong data literacy (Excel/dashboarding).
- Outstanding communication skills with patients, families, clinicians, and payers.
Experience
- 7–10 years of progressive experience in hospital case management, care coordination, or utilisation management.
- 3+ years in a senior/lead role, supervising teams or leading complex programs.
- Demonstrated success reducing LOS/readmissions, improving throughput, and managing payer interactions/denials.
Working Hours
- Full-time, typically 40–45 hours per week.
- Flexibility for on-call/weekend/public holiday rotations to support patient flow and urgent discharge needs.
Knowledge, Skills, and Abilities
- In-depth understanding of continuum of care, post-acute networks, and social determinants of health.
- Knowledge of clinical pathways, bundled payments, population health, and value-based care.
- Ability to interpret clinical documentation for medical necessity and level-of-care determinations.
- High emotional intelligence, cultural competence, and patient/family engagement skills.
- Strong organisational skills with the ability to manage multiple complex cases simultaneously.
- Change management aptitude to lead process improvements and drive adoption across teams.
Benefits (Illustrative; final package will align with Mediclinic policy & local regulations)
- Competitive salary with performance-linked incentives.
- Comprehensive health, dental, and vision insurance.
- Retirement/Provident fund contributions.
- Generous paid time off, sick leave, and parental leave.
- Continuing education support, certification sponsorship, and professional development programs.
- Employee wellness initiatives and mental health support.
- Opportunities to participate in research, quality improvement, and leadership academies.
Why Join Mediclinic?
- Impact at scale: Shape care pathways and outcomes across a leading healthcare organisation.
- Clinical + operational leadership: Operate at the intersection of patient care, quality, and financial stewardship.
- Growth & learning: Access structured leadership development, certifications, and cross-functional projects.
- Culture of excellence: Work with multidisciplinary experts committed to evidence-based, patient-centred care.
- Innovation and data: Leverage analytics and digital tools to transform case management practices.
How to Apply
- Prepare your application:
- Updated CV/Resume highlighting case management leadership, utilisation review expertise, and measurable KPIs (LOS, readmission rate reductions, denial overturn rates, etc.).
- Short cover letter outlining your most complex coordination case and impact.
- Copies of relevant licenses/certifications (e.g., RN, CCM, ACM).
- Submit online:
- Apply via the Mediclinic Careers Portal under “Senior Hospital Case Manager – Patient Care Coordination”.
- Interview process (indicative):
- HR screening → Panel interview with Nursing/Medical leadership → Case-based assessment → Final discussion on strategy/KPIs.
Mediclinic is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. Candidates will be screened in line with safeguarding and regulatory requirements.