Case Manager | General Ward

LIFE Healthcare Group; Mpumalanga; On-site; ZAR 200,000 - 300,000; Full time

Job summary

A healthcare facility in Mpumalanga is seeking a Case Manager for the General Ward. The role involves managing financial and clinical risks, ensuring accurate coding, and maintaining strong relationships with stakeholders. Candidates must possess a relevant nursing degree and be SANC registered. Strong problem-solving skills and attention to detail are essential. This is an opportunity to contribute to operational excellence and patient care in a dynamic environment.

Qualifications

• Current SANC registration is required.
• Knowledge of hospital patient services and case management processes.
• Understanding of private hospital industry and practices is essential.

Responsibilities

• Manage financial and clinical risks in the general ward.
• Ensure accuracy in coding and accounts submissions.
• Implement quality improvement programmes.

Skills

Attention to detail

Problem-solving

Verbal & written communication skills

Customer responsiveness

Organisational awareness

Education

Diploma or degree in Nursing or related fields

Job description

A vacancy exists for a Case Manager General Ward based at Life Cosmos Hospital, Mpumalanga, reporting to Anrita Engelbrecht, 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 recommending corrective actions
• Monitoring insurance verification and workflow processes

Ensuring effective management of quality outputs by:

• Performing quality walkabouts and implementing 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 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 for general ward and specialised cases
• Releasing care risk targets and submissions within two days of discharge
• Ensuring compliance with LHC policies and managing authorisations, claim submissions, rejections, and delays
• Ensuring governance and risk management by monitoring and adhering to patient services policies and procedures
• Ensuring compliance with service level agreements with stakeholders
• Ensuring all billing checks are closed by relevant areas

Ensuring effective stakeholder relationship management by:

• Building and maintaining relationships with internal stakeholders
• Providing feedback and addressing concerns raised by internal stakeholders
• Providing and facilitating training on RSRT contracts to internal stakeholders
• Ensuring effective communication with external stakeholders
• Managing escalated concerns from Case Managers with external stakeholders
• Escalating doctor non-compliance issues to RSRT meetings

Requirements

• Diploma or degree in Nursing, Physiotherapy, Clinical Associates, Paramedics, or related fields covering Anatomy, Physiology, Pathophysiology, and Microbiology
• 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 judgment
• 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

Application email: [e-mail]. Closing date: Thursday, August 14, 2025.

Internal applicants are encouraged to discuss their application with their line manager before applying. External candidates will also be considered.

Life Healthcare is an Equal Opportunity Employer.

Note: Only shortlisted candidates will be contacted. If you have not been contacted within two weeks after the closing date, please consider your application unsuccessful.