Case Manager | Specialised South Africa

Life Healthcare is actively recruiting for a Case Manager | Specialised position in South Africa. This is an excellent opportunity for professionals in the Medical / Healthcare sector looking to advance their careers.

• Experience Level: Not Specified • Educational Background: Others or equivalent • Industry Focus: Medical / Healthcare • Location Preference: in South Africa

Healthcare professionals including Case Manager | Specialised are essential service providers. This role contributes directly to community health and wellbeing.

This role in Medical / Healthcare offers valuable career progression opportunities aligned with your experience level and professional aspirations.

When applying for this Case Manager | Specialised position, ensure your CV highlights: • Relevant experience matching the Not Specified requirement • Educational qualifications in line with Others • Specific achievements in the Medical / Healthcare field • Any certifications or specialized training

The Medical / Healthcare sector in South Africa continues to show strong demand for skilled professionals. This position represents a valuable opportunity in the current job market.

---

A vacancy exists for a Case Manager Specialised Units, based at Life Cosmos Hospital, Mpumalanga, reporting to Anrita Engelbrecht, Patient Services Manager. The successful candidate will be responsible for the management of the financial and clinical administrative risks pertaining to patients in specialised units – Intensive care units, high care units and neonatal intensive care units.

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 of specialised 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

Diploma or degree in Nursing, Physiotherapy, Clinical Associates, Paramedics as Critical Care Assistants or Emergency Care Practitioners or any other qualification that covers Anatomy, Physiology, Pathophysiology and Microbiology as foundational courses. Experience including proven leadership, change and people management Current registration with the relevant professional / regulatory body (South African Nursing Council) 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 Resilience Engaging diversity Verbal & written communication and presentation Influencing Drive & energy Excellence orientation Ethical behaviour Building relationships Customer responsiveness Organisational awareness Leading my example (Key for Managers) Motivating and developing people(Key for Managers)

Deadline:18th August,2026