Case Manager | General Ward
Job in
Pretoria, 0002, South Africa
Listing for:
Life Healthcare
Full Time
position
Listed on 2026-01-19
Job specializations:
-
Healthcare
Healthcare Administration, Healthcare Management
Job Description & How to Apply Below
Function Patient services Facility Position Case Manager | General Ward Introduction
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.
Critical Outputs
Ensuring the maximisation of revenue by
Ensuring accuracy of codingEnsuring the correct application and interpretation of RSRT’sParticipating in meetings and reporting losses to RSRT team and recommend corrective actionsMonitoring insurance verification and workflow processesEnsuring effective management of quality outputs by
Performing quality walkabouts and implement corrective measuresImplementing and monitoring quality improvement programmesAdhering to patient services escalation processes in order to achieve QMS targetsMonitoring Q-evaluator scores and implementing corrective measuresInvestigating internal and external stakeholder complaintsEnsuring the adherence to customer service standardsEnsuring operational excellence by
Monitoring submission of accurate accounts to fundersUpdating 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 dischargeEnsuring the compliance to LHC policies and managing authorisations and claim submissions, rejections and delaysEnsuring governance and risk management by monitoring and adhering to patient services policies and proceduresEnsuring compliance to service level agreements with internal and external stakeholdersEnsuring all billing checks are closed by the relevant function areasEnsuring effective management of relationships with internal/external stakeholders by
Building and maintaining relationships with internal stakeholdersProviding feedback and information on concerns or issues raised by internal stakeholdersProviding and facilitating training regarding RSRT contracts to the relevant internal stakeholdersEnsuring effective communication with external stakeholdersManaging escalated concerns from Case Managers with external stakeholdersEscalating doctor non-compliance in terms of RSRT framework to RSRT meetingsRequirements
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 registrationKnowledge of hospital patient services and case management processesKnowledge and understanding of CPT & ICD codingKnowledge of Funder contracts, scheme rules, exclusions and benefitsUnderstanding of private hospital industry and practicesComputer proficiencyCompetencies
Attention to detailProblem-solving, analysis and judgementResilienceEngaging diversityVerbal & written communication skillsProfessional and technical proficiencyBuilding relationshipsCustomer responsivenessOrganisational awarenessInfluencing skillsAction orientationExcellence orientationEthical behaviour
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