Case Manager | General Ward

LIFE Healthcare Group; Cape Town; On-site; ZAR 300 000 - 500 000; Full time

Job summary

An established industry player is seeking a dedicated Case Manager for a 6-month contract at a private hospital. This role involves managing patient financial and clinical risks, ensuring accurate coding, and maintaining high-quality patient services. The successful candidate will play a crucial role in enhancing operational excellence and fostering relationships with various stakeholders. If you are a detail-oriented professional with a nursing background and a passion for patient care, this opportunity offers a chance to make a significant impact in a dynamic healthcare environment. Join a team that values excellence and commitment to quality service.

Qualifications

• Diploma or degree in Nursing or related field required.
• Current SANC registration is mandatory for applicants.

Responsibilities

• Manage financial and clinical risks of patients in a general ward.
• Ensure accurate coding and clinical updates for patient hospitalization.
• Build relationships with internal and external stakeholders.

Skills

Attention to detail

Problem-solving

Verbal & written communication skills

Customer responsiveness

Education

Diploma or degree in Nursing

Current SANC registration

Qualification covering Anatomy, Physiology, Pathophysiology and Microbiology

Tools

Computer proficiency

Job description

A 6-month Case Manager General Ward contract is currently available, based at Life Bay View Private Hospital, reporting to Susan Visser, 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 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 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
• When either operationally required, relieve as or specialised case manager, bill auditor or pre admission clinical assessor.

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 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 Tuesday, April 29, 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.