Case Manager General

A vacancy exists for a Case Manager General Ward based at Life Beacon Bay Hospital reporting to Cindy Lee Prince, Patient Services Manager. The successful candidate will manage the financial and clinical risks of patients in a general ward by ensuring accurate coding, clinical updates and accounts submissions of patient hospitalisations to achieve strategic objectives.

Responsibilities include managing financial and clinical risks and ensuring accurate coding and account submissions.

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 the RSRT team and recommending corrective actions
• Monitoring insurance verification and workflow processes

• Performing quality walk abouts 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 internal and external stakeholder complaints
• Ensuring adherence to customer service standards

• 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 with 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

• 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 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

• 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

• 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:

Closing date: Friday, February 20, 2026

Internal applicants - before making an application, 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 unsuccessful.