Specialised Case Manager – Hospital

About the role

The hospital is seeking a Specialised Case Manager to join the Patient Services team at Life Beacon Bay Hospital in Johannesburg. Reporting to the Patient Services Manager, the role focuses on managing financial and clinical risks for patients in general wards through accurate coding, clinical updates and timely account submissions.

Key responsibilities

• Conduct ward rounds and collect complete clinical data from patient files, liaising with nursing staff and attending clinicians.
• Update clinical information to justify length of stay and level of care for specialised unit and general ward cases.
• Provide funders with required information on high‑value items, limited benefits and protocol compliance.
• Communicate funder requirements and responses to clinicians and patients, ensuring adherence to industry standards.
• Manage real‑time and manual messaging, including requests, responses, rejections and submissions.
• Submit accurate accounts to funders and ensure compliance with governance, risk management and service level agreements.
• Maintain accurate coding of patient accounts and apply RSRT contracts and fee‑for‑service claims correctly.
• Report identified RSRT risks to management and follow escalation processes for non‑compliance.
• Build and maintain relationships with internal and external stakeholders, providing training on RSRT contracts and feedback on process efficiency.

Required profile

• Grade 12 National Senior Certificate.
• Diploma or degree in Nursing, Physiotherapy, Clinical … (as stated).
• Experience in hospital case management, clinical documentation and funder liaison.
• Strong understanding of patient services policies, risk management and governance requirements.

Required skills

• Clinical coding.