Case Manager

About the role

The Case Manager will oversee financial and clinical administrative risks for patients at Life Fourways Hospital, ensuring high‑quality service and accurate clinical coding.

Key responsibilities

• Maximise revenue by ensuring accurate CPT and ICD coding and correct application of RSRTs.
• Monitor insurance verification, funder submissions, and length‑of‑stay updates.
• Conduct quality walk‑abouts, implement improvement programmes, and manage Q‑evaluator scores.
• Maintain compliance with hospital policies, service level agreements, and funder contracts.
• Build and maintain relationships with internal and external stakeholders, providing training on RSRT contracts.

Required profile

• Diploma or degree in Nursing, Physiotherapy, Clinical Associates, Paramedics, or related health fields.
• Current registration with the South African Nursing Council (SANC).
• Knowledge of hospital patient services, case management processes, and private‑hospital industry practices.
• Understanding of CPT & ICD coding, funder contracts, scheme rules, exclusions and benefits.

Required skills

• Clinical coding according to CPT and ICD standards.
• Computer proficiency for electronic submission of accounts and data management.