Case Manager | Specialised

Function

Nursing

Facility

Life Eugene Marais Hospital

Position

Case Manager | Specialised

Introduction

A vacancy exists for a Case Manager Specialised based at Life Eugene Marais Hospital, reporting to 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 operational excellence by:

• Conducting ward rounds and ensuring the accurate complete collection of clinic data from patient files and liaisons with nursing staff and attending clinicians

• Updating accurate clinical information to justify length of stay, and level of care to medical funds for specialized unit cases and, where operationally required general ward cases.

• Updating and providing the necessary information to funders regarding high value items, limited benefits and protocols as defined by managed care organizations
• Communicating funder requirements / responses to attending clinicians and patients where necessary, and ensuring compliance with industry standards
• Ensuring effective management of real time and manual messaging, including requests, responses, rejections and submissions.
• Ensuring the accurate submission of accounts to funders.
• Complying with governance and risk management requirements by ensuring adherence to patient services policies and procedures
• Ensuring compliance to service level agreements with internal and external stakeholders

 Ensuring effective management of revenue by

• Ensuring the accurate and complete coding of patient accounts
• Ensuring the correct application and correct interpretation of funder RSRT contracts and FFS claims
• Reporting RSRT risks identified to the relevant manager

Ensuring effective management of quality outputs by

• Adhering to patient services escalation processes and customer services standards
• Investigating and reporting published alerts incidents and agreeing upon appropriate action with internal and external stakeholders

Ensuring effective management of relationships with internal/external stakeholders by

• Building and maintaining relationships with internal stakeholders
• Providing and facilitating training regarding RSRT contracts
• Providing feedback and information regarding concerns or issues raised by external stakeholders
• Providing feedback on external stakeholders impacting on the efficiency and effectiveness of the case management process
• Escalating doctor non-compliance in terms of RSRT framework to RSRT meetings

Requirements

• Grade 12 National Senior Certificate
• Diploma or degree in Nursing, Physiotherapy, Clinical Associate, Paramedics as Critical Care Assistant or Emergency Care Practitioner or any other qualification that covers Anatomy, physiology, Pathophysiology and Microbiology as foundational courses.
• Nursing qualification, Registered Nurse with at least five years’ experience on which at least 2 should be in a specialized unit
• Knowledge of hospital patient services and case management processes
• Experience including proven leadership, change and people management
• Current SANC registration
• Understanding of clinical coding, clinical terminology and anatomy, funder rules, co-payments and exclusions
• Working knowledge of COID
• Understanding of business and change management principles
• Computer proficiency

Competencies

• Problem-solving, analysis and judgement
• Attention to detail
• Resilience
• Engaging diversity
• Professional and technical proficiency
• Excellence orientation
• Building relationships
• Customer responsiveness
• Organisational awareness
• Action orientation
• Ethical behaviour

Email

Careers.Emh@lifehealthcare.co.za

Closing date

Monday, August 10, 2026