Case Manager | General Ward

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

Job summary

A private healthcare institution in South Africa is seeking a Case Manager for the General Ward. The ideal candidate will be responsible for managing financial and clinical risks of patients, ensuring accurate coding, and monitoring workflow processes. Candidates must have a relevant diploma or degree with current SANC registration. Attention to detail and strong communication skills are essential.

Qualifications

• Current SANC registration.
• Knowledge of hospital patient services, case management, coding, and funder contracts.
• Understanding of private hospital industry practices.

Responsibilities

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

Skills

Attention to detail

Problem-solving and analysis

Communication skills

Customer responsiveness

Education

Diploma or degree in Nursing, Physiotherapy, Clinical Assistance, Paramedics

Job description

A vacancy exists for a Case Manager General Ward based at Life Hilton Private Hospital, reporting to the Finance and Administration Manager, Mandy Ruthanum. The successful candidate will be responsible for managing the financial and clinical risks of patients in a general ward by ensuring accurate coding, clinical updates, and account submissions of patient hospitalizations to achieve strategic objectives.

Critical Outputs

Ensuring the maximisation of revenue by:

• Ensuring accuracy of coding
• Ensuring the correct application and interpretation of RSRTs
• Participating in meetings, reporting losses to the 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 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 information to funders for general ward and specialized unit cases
• Releasing care risk targets and submissions within two days of discharge
• Ensuring compliance with LHC policies and managing authorisations, claims, rejections, and delays
• Monitoring and adhering to patient services policies and procedures for governance and risk management
• Ensuring compliance with service level agreements
• Closing billing checks in relevant areas

Managing relationships with stakeholders by:

• Building and maintaining internal relationships
• Providing feedback and training on RSRT contracts
• Communicating effectively with external stakeholders
• Managing escalated concerns and non-compliance issues

Requirements

• Diploma or degree in Nursing, Physiotherapy, Clinical Assistance, Paramedics, or related fields covering Anatomy, Physiology, Pathophysiology, and Microbiology
• Current SANC registration
• Knowledge of hospital patient services, case management, CPT & ICD coding, and funder contracts
• Understanding of private hospital industry practices
• Computer proficiency

Competencies

• Attention to detail
• Problem-solving and analysis
• Resilience
• Engaging diversity
• Communication skills
• Professional proficiency
• Relationship building
• Customer responsiveness
• Organisational awareness
• Influencing skills
• Action and excellence orientation
• Ethical behaviour

Application email: [e-mail]. Closing date: Friday, August 8, 2025.

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

Life Healthcare is an Equal Opportunity Employer. Only shortlisted candidates will be contacted. If you haven't heard from us within two weeks after the closing date, please consider your application unsuccessful.