Case Manager & General Ward

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

Job summary

A healthcare organization based in Pinetown seeks a Case Manager General. The successful candidate will manage patient financial and clinical risks in a general ward, ensuring accurate coding and timely account submissions. Ideal applicants should hold a Diploma or degree in a relevant field, possess current SANC registration, and have experience in hospital services and case management processes. Skills required include strong attention to detail, problem-solving abilities, and effective communication. Applications must be submitted by February 11, 2026, to [e-mail].

Qualifications

• Diploma or degree with courses in Anatomy, Physiology, Pathophysiology, and Microbiology.
• Knowledge of hospital patient services and case management processes.
• Understanding of CPT & ICD coding.

Responsibilities

• Manage financial and clinical risks of patients in a general ward.
• Ensure accuracy of coding and submission of accounts.
• Implement and monitor quality improvement programmes.

Skills

Attention to detail

Problem-solving

Communication skills

Customer responsiveness

Education

Diploma or degree in Nursing or related field

Current SANC registration

Tools

Computer proficiency

Job description

Overview

A vacancy exists for a Case Manager General based at Life The Crompton Hospital, reporting to Praviksha Bailey, Finance and Admin 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

• 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 Wednesday, February 11, 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.