Job Description

Career Opportunity: Case Manager Spinal Programme Management
Location: Pretoria (On-site)
Contract Type: Permanent
Salary: Market-related Cost to Company (including medical aid, provident fund, etc.) Based on experience
About our client:
Our client is a trusted and accredited managed healthcare organisation serving clients in the medical scheme industry. They are proud to support one of South Africas fastest-growing medical schemes and are expanding our specialist services to ensure members receive effective, value-driven healthcare. They are now seeking a skilled and compassionate Case Manager to join our dedicated Spinal Programme Management team.
Purpose of the Role
As a Case Manager, you will play a critical role in managing access, clinical appropriateness, and the financial and medical risk associated with spinal healthcare services. These include back and neck pain interventions, spinal surgeries, imaging, and conservative treatment pathways such as physiotherapy. Your role will require you to evaluate, guide, and coordinate care in line with scheme rules, clinical protocols, and funding guidelines.
Minimum Qualifications

• Registered Nurse with valid SANC registration

OR * Clinical Associate with a Bachelor of Clinical Medical Practice (BCMP) and valid HPCSA registration
Key Skills & Competencies

• Strong clinical knowledge of hospital admissions, Length of Stay (LOS), and Level of Care (LOC)
• Excellent understanding of the SA healthcare landscape, coding standards (ICD-10, CPT4), NRPL, PMB legislation, and treatment protocols
• Working knowledge of spinal, neuro-, and orthopaedic surgical environments (advantageous)
• Experience in managed care, case management, or related fields
• Familiarity with value-based care and holistic patient management
• Proficiency in MS Office (especially Excel) and experience with MIP systems (advantageous)
• Exceptional written and verbal communication skills (English required; proficiency in additional national languages is a plus)
• High emotional intelligence, attention to detail, and the ability to handle sensitive or complex cases with empathy
• Strong decision-making, prioritisation, and multi-tasking skills

Key Responsibilities

• Evaluate service requests, surgical quotations, and clinical codes related to spinal conditions
• Coordinate closely with the Medical Advisor and act on guidance received
• Engage with healthcare providers, members, and hospital case managers
• Manage hospitalised patients and facilitate discharge planning and follow-ups
• Perform case reviews and authorisation assessments
• Prepare documentation, clinical reports, and case studies as required
• Ensure accurate and timeous case record keeping and communication with stakeholders
• Continuously monitor and assess treatment efficacy, costs, and member outcomes
• Contribute to improving processes within the Spinal Programme and broader managed healthcare team

Additional Requirements

• Ability to work independently and manage a caseload under pressure
• Willingness to work overtime when needed to meet workflow targets
• High professional integrity and confidentiality in handling patient data
• Internal applicants must consult their Line Manager before applying