Case Manager | General

LIFE Healthcare Group; Rustenburg; On-site; ZAR 300,000 - 400,000; Full time

Job summary

A healthcare facility in Rustenburg is looking for a Case Manager General. This role involves managing the financial and clinical risks of patients in a general ward. The ideal candidate should have a nursing qualification, relevant experience, and a current SANC registration. Strong relationship management and problem-solving skills are essential. If you are passionate about patient care and quality improvement, apply now.

Qualifications

• Professional Nurse with at least three years’ experience or Enrolled Nurse with 3-5 years of case manager experience.
• Current SANC registration required.
• Knowledge of hospital patient services and case management processes.

Responsibilities

• Manage financial and clinical risks of patients in a general ward.
• Ensure compliance with hospital policies and procedures.
• Build and maintain relationships with stakeholders.

Skills

Attention to detail

Problem-solving

Verbal communication skills

Organisational awareness

Education

Grade 12 National Senior Certificate

Nursing Qualification

Tools

Computer proficiency

Job description

Overview

A vacancy exists for a Case Manager General, based at Life Peglerae Hospital, reporting to Suzette van Rensburg, Patient Services Manager. The successful candidate will be responsible for managing the financial and clinical risks of the patient in a general ward by ensuring accurate coding, clinical updates and accounts submissions of patient hospitalization to achieve strategic objectives.

Introduction

A vacancy exists for a Case Manager General, based at Life Peglerae Hospital, reporting to Suzette van Rensburg, Patient Services Manager. The successful candidate will be responsible for managing the financial and clinical risks of the patient in a general ward by ensuring accurate coding, clinical updates and accounts submissions of patient hospitalization to achieve strategic objectives.

Critical Outputs

Ensuring the maximisation of revenue by

• Ensuring accuracy of coding
• Ensuring the correct application and interpretation of RSRT’s
• Participating in meetings and reporting losses to RSRT team and recommend corrective actions
• Monitoring insurance verification and workflow processes

Ensuring effective management of quality outputs by

• Performing quality walkabouts and implement corrective measures
• Implementing and monitoring quality improvement programmes
• Adhering to patient services escalation processes in order to achieve QMS targets
• Monitoring Q-evaluator scores and implementing corrective measures
• Investigating internal and external stakeholder complaints
• Ensuring the adherence to customer service standards

Ensuring operational excellence by

• Monitoring submission of accurate accounts to funders
• Updating length of stay and level of care to funders of general ward cases and where operationally required specialised unit cases.
• Releasing care risk targets and submission within two days of discharge
• Ensuring the compliance to LHC policies and managing authorisations and claim submissions, rejections and delays
• Ensuring governance and risk management by monitoring and adhering to patient services policies and procedures
• Ensuring compliance to service level agreements with internal and external stakeholders
• Ensuring all billing checks are closed by the relevant function areas

Ensuring effective management of relationships with internal/external stakeholders by

• Building and maintaining relationships with internal stakeholders
• Providing feedback and information on concerns or issues raised by internal stakeholders
• Providing and facilitating training regarding RSRT contracts to the relevant internal stakeholders
• Ensuring effective communication with external stakeholders
• Managing escalated concerns from Case Managers with external stakeholders
• Escalating doctor non-compliance in terms of RSRT framework to RSRT meetings

Requirements

• Grade 12 National Senior Certificate
• Nursing Qualification, preferably Professional Nurse with at least three years’ experience or Enrolled Nurse with proven case manager and clinical coding experience of at least 3 -5 years.
• Current SANC registration
• Knowledge of hospital patient services and case management processes
• Knowledge and understanding of CPT & ICD coding
• Knowledge of Funder contracts, scheme rules, exclusions and benefits
• Understanding of private hospital industry and practices
• Computer proficiency

Competencies

• Attention to detail
• Problem-solving, analysis and judgement
• Resilience
• Engaging diversity
• Verbal & written communication skills
• Professional and technical proficiency
• Building relationships
• Customer responsiveness
• Organisational awareness
• Influencing skills
• Action orientation
• Excellence orientation
• Ethical behaviour

Email [e-mail]

Closing date Monday, September 22, 2025

Internal applicants - Before making an application, you are requested to discuss your application with your line manager.

External candidates will also be considered.

Life Healthcare is an Equal Opportunity Employer.

Thank you for your interest in this opportunity. Kindly note that only shortlisted candidates will be contacted. Applicants who have not been contacted within two weeks of the closing date of this advert, should consider their application as unsuccessful.