General Case Manager

About the role

The General Case Manager will work at Life Flora Hospital reporting to the Patient Services Manager. The role focuses on managing financial and clinical risk for patients in general wards by ensuring accurate coding, timely account submissions, and compliance with internal policies.

Key responsibilities

• Maximise revenue through accurate medical coding and correct application of RSRT contracts.
• Monitor insurance verification, workflow processes and submit accurate accounts to funders within required timeframes.
• Conduct quality walk‑abouts, implement corrective actions and drive quality‑improvement programmes.
• Manage escalations, investigate stakeholder complaints and ensure adherence to customer‑service standards.
• Maintain compliance with LHC policies, service‑level agreements and governance procedures.
• 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 (Critical Care Assistant) or Emergency Care Practitioner, or any qualification covering anatomy, physiology, pathophysiology and microbiology.
• Current registration with the South African Nursing Council (SANC) or equivalent professional body.

Required skills

• Medical coding
• Clinical documentation
• Insurance verification
• Quality improvement methodologies
• Risk management
• Billing and claims processing