General Case Manager – Patient Services

About the role

A vacancy exists for a Case Manager General at Life Wilgeheuwel Hospital, reporting to the Patient Services Manager. The role focuses on managing financial and clinical risks for patients in general wards by ensuring accurate coding, clinical updates, and timely account submissions.

Key responsibilities

• Maximise revenue through accurate medical coding and correct application of RSRT contracts.
• Monitor insurance verification, workflow processes, and ensure timely claim submissions.
• Perform quality walkabouts, implement corrective measures, and drive quality improvement programmes.
• Adhere to patient services escalation processes and meet QMS targets.
• 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 and handling escalated concerns.

Required profile

• Diploma or degree in Nursing, Physiotherapy, Clinical Associates, Paramedics (Critical Care Assistants or Emergency Care Practitioners) or equivalent qualification covering anatomy, physiology, pathophysiology and microbiology.
• Current registration with the South African Nursing Council (SANC) or relevant professional body.

Required skills

• Medical coding
• Insurance verification
• Quality improvement programme implementation
• Billing and claim submission
• Regulatory compliance and RSRT contract management