Case Manager General Units

LIFE Healthcare Group; Cape Town; On-site; ZAR 400 000 - 600 000; Full time

Job summary

A leading healthcare provider is seeking a Case Manager for General Wards in Cape Town. The successful candidate will manage patient risks and ensure accurate coding of clinical updates. Key responsibilities include monitoring insurance processes, managing stakeholder relationships, and ensuring adherence to healthcare policies. Ideal candidates should possess a nursing degree or equivalent and have a solid understanding of case management processes. This position offers significant engagement with clinical and administrative tasks to optimize patient care delivery.

Qualifications

• Current registration with relevant professional body (e.g. SANC, HPCSA).
• Knowledge of hospital patient services and case management processes.
• Understanding of CPT & ICD coding.

Responsibilities

• Manage financial and clinical risks of patients in general wards.
• Ensure accurate coding and clinical updates.
• Monitor insurance verification processes.

Skills

Problem-solving

Communication

Team management

Analytical skills

Customer responsiveness

Education

Diploma or degree in Nursing, Physiotherapy, or related field

Tools

Computer proficiency

Job description

Overview

A vacancy exists for a Case Manager, General Wards, based at Life Name Vincent Pallotti Hospital, reporting to Jo Van Staden, 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

Quality outputs

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

Operational excellence

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

Stakeholder relationships

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

• Diploma or degree in Nursing, Physiotherapy, Clinical Associates, Paramedics as Critical Care Assistants or Emergency Care Practitioners or any other qualification that covers Anatomy, Physiology, Pathophysiology and Microbiology as foundational courses.
• Current registration with relevant professional body e.g. SANC, HPCSA
• 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

• Problem-solving, analysis and judgement
• Resilience
• Engaging diversity
• Verbal & written communication and presentation
• Influencing
• Action orientation
• Building relationships
• Customer responsiveness
• Organisational awareness
• Leading by example
• Motivating and developing people
• Excellence orientation
• Ethical behaviour

Email: [e-mail]

Closing date: Monday, February 9, 2026

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.