Case Manager General | General Ward

In brief

Overview This role is for a Case Manager General based at Life Flora Hospital, reporting to Gail Bunting, Patient Services Manager, within Life Healthcare. The position is responsible for managing the financial and clinical risks associated with patients in a general ward by ensuring accurate coding, clinical updates, and timely submission of patient hospitalization accounts to achieve strategic objectives. What you will do The successful candidate will be responsible for: * **Ensuring the maximisation of revenue by:** * Ensuring accuracy of coding. * Ensuring the correct application and interpretation of RSRT’s (Relative Stay Review Targets). * Participating in meetings and 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 in order to achieve QMS (Quality Management System) 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. * **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 the RSRT framework to RSRT meetings. Requirements (from the original advert) * 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. Who should apply The ideal candidate for this role should possess a relevant diploma or degree in nursing or allied health fields (including Physiotherapy, Clinical Associates, Paramedics as Critical Care Assistants, or Emergency Care Practitioners) with foundational knowledge in Anatomy, Physiology, Pathophysiology, and Microbiology. Current registration with SANC is a mandatory requirement. Applicants should demonstrate knowledge of hospital patient services, case management processes, CPT & ICD coding, and funder contracts, including scheme rules, exclusions, and benefits. An understanding of the private hospital industry and its practices, along with computer proficiency, is also necessary. Critical competencies for this role include attention to detail, problem-solving, analysis and judgement, resilience, engaging diversity, strong verbal and written communication skills, professional and technical proficiency, relationship-building, customer responsiveness, organisational awareness, influencing skills, action orientation, excellence orientation, and ethical behaviour. Deadline 9th October, 2026 Reference Original posting: https://www.myjobmag.co.za/job/case-manager-general-general-ward-life-healthcare Source: myjobmag

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