MANAGER: HOSPITAL CASE MANAGEMENT

22/05/2025 admin RAF JOBS 0

MANAGER: HOSPITAL CASE MANAGEMENT – GROOTE SCHUUR / TYGERBERG HOSPITAL | ROAD ACCIDENT FUND – CAPE TOWN, WESTERN CAPE

Company: Road Accident Fund
Location: Cape Town, Western Cape, South Africa
Date Posted: May 2025
Reference Number: 5686
Employment Type: Permanent
Disability (EE Targeted Role): No
T.A.S.K Grade: 16
Annual Salary: R1,028,791.00
Closing Date: 27 May 2025

ABOUT THE COMPANY

The Road Accident Fund (RAF) is a key state-owned public entity in South Africa, dedicated to compensating individuals who are seriously injured due to road accidents. RAF’s mission is to rehabilitate and reintegrate injured persons into society through efficient financial assistance, medical care coordination, and ongoing support. By promoting road safety and ensuring legal compliance, the RAF plays a vital role in supporting victims, their families, and the overall public healthcare system.

ROLE OVERVIEW

As the Manager: Hospital Case Management based at Groote Schuur and Tygerberg Hospital in Cape Town, the successful candidate will oversee the delivery of structured and high-quality medical care to motor vehicle accident (MVA) claimants. This strategic and clinical leadership role involves developing hospital case management strategies, overseeing claimant care planning, managing provider relationships, validating invoices, and ensuring optimal rehabilitation outcomes.

KEY RESPONSIBILITIES

POLICY REVIEW AND IMPLEMENTATION

  • Implement and refine case management policies in line with RAF’s long-term objectives

  • Manage the application of strategy and assigned special projects

  • Monitor alignment of operational plans with healthcare and claimant recovery outcomes

CLINICAL CARE MANAGEMENT

  • Oversee clinical case assessments and ensure appropriate medical interventions

  • Validate diagnostic and procedural coding in accordance with accepted standards

  • Ensure medical care meets quality standards and contributes to positive recovery trajectories

  • Support continuous improvement by identifying training needs of senior case officers

CLAIMANT CARE MANAGEMENT

  • Substantiate hospital stays and care levels to ensure necessity and cost efficiency

  • Coordinate comprehensive medical assessments and track recovery progress

  • Oversee discharge planning and post-hospital treatment alignment

  • Ensure availability of amenities and utilities for full recovery

  • Recommend facility transfers and cost-effective treatment pathways

CASE ADMINISTRATION AND REPORTING

  • Develop clinical practice guidelines and care standards

  • Lead multidisciplinary case discussions and conferences

  • Monitor financial and business risks related to claimant care

  • Present high-cost case reviews and provide strategic input

INVOICE VALIDATION AND FINANCIAL COMPLIANCE

  • Validate and quality-check all submitted invoices

  • Ensure invoices are aligned with services rendered

  • Prevent fraud by implementing strict control mechanisms

  • Enforce timely and compliant payments to healthcare providers

STAKEHOLDER RELATIONSHIP MANAGEMENT

  • Engage with hospital staff, claimants, and external healthcare partners

  • Build sustainable relationships with funders and public stakeholders

  • Provide expert guidance and manage service expectations

PEOPLE MANAGEMENT

  • Recruit and manage a performance-driven team

  • Align human capital development with strategic healthcare goals

  • Ensure performance monitoring and conflict resolution procedures are followed

QUALIFICATIONS AND EXPERIENCE

  • Bachelor’s Degree or Advanced Diploma in a health sciences or medical field

  • A postgraduate qualification in Health Sciences is advantageous

  • Registered with a relevant professional health body

  • Minimum 6–8 years in nursing or case management, with at least 2 years in a leadership role

  • ICU, Theatre, or high-cost case management experience is an asset

BEHAVIOURAL COMPETENCIES

  • Resilience and strong interpersonal communication

  • Planning, coordination, and employee engagement

  • Ethical conduct, client service focus, and personal mastery

  • Sound judgment and decision-making under pressure

MANAGERIAL COMPETENCIES

  • Change leadership, conflict management, and risk mitigation

  • Coaching, mentoring, and team development

  • Strategic direction setting and performance oversight

  • Policy formulation and stakeholder engagement

TECHNICAL COMPETENCIES

  • In-depth knowledge of case management systems and processes

  • Familiarity with ICD and CPT coding, medical claims processing

  • Strong understanding of MVA legislation and PFMA compliance

  • Expertise in dispensing procedures and surgical material protocols

WHAT THE COMPANY OFFERS
RAF offers Total Employment Cost (TEC) packages. There are no additional employer contributions, and successful candidates are required to structure their salary packages to suit personal needs. This approach supports financial independence and flexible benefits management.

EQUAL OPPORTUNITY STATEMENT
The Road Accident Fund is committed to employment equity. Preference may be given to persons living with disabilities. All appointments will be made in line with RAF’s Employment Equity Plan. Security vetting will be conducted. Applicants with foreign qualifications must ensure SAQA evaluation and submit proof.

HOW TO APPLY
Applications must be submitted no later than 27 May 2025. If you have not received feedback within six weeks from the closing date, please consider your application unsuccessful. Visit the official RAF site for updates on the recruitment process.

EXPLORE MORE HIGH-IMPACT CAREER OPPORTUNITIES
For candidates seeking similar roles in the public healthcare or case management field, we recommend exploring these listings:

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