Case Manager & General Ward

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

Job summary

A leading healthcare provider in Pretoria is seeking a Case Manager for the General Ward. The successful candidate will oversee the financial and clinical management of patients, ensuring accurate coding and timely submission of accounts. Applicants must have a relevant nursing degree and SANC registration, with strong organizational and communication skills. This role offers a chance to impact patient care positively within a dynamic hospital environment.

Qualifications

• Current SANC registration required.
• Understanding of private hospital industry and practices is essential.
• Computer proficiency is mandatory.

Responsibilities

• Manage financial and clinical risks of hospitalized patients.
• Ensure accurate coding and timely accounts submissions.
• Monitor submission of accurate accounts to funders.

Skills

Knowledge of hospital patient services

Knowledge of CPT & ICD coding

Attention to detail

Verbal & written communication skills

Problem-solving

Education

Diploma or degree in Nursing, Physiotherapy, or related fields

Job description

A vacancy exists for a Case Manager General Ward based at Life Wilgers Hospital, reporting to the 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.

Function Patient services Facility Life Wilgers Hospital Position Case Manager | General Ward Introduction

Critical Outputs

• 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

Effective Management of Quality Outputs

• 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

• 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

Effective Management of Relationships with Internal/External Stakeholders

• 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: Monday, January 26, 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.