Life Gaborone Private Hospital

Introduction:

A vacancy exists for a Case Manager based at Life Gaborone Private Hospital, reporting to the Patient Services Manager. The successful candidate will be responsible for managing the financial and clinical risks of the patients by ensuring accurate coding, clinical updates and accounts submissions of patient hospitalization to achieve strategic objectives.

Critical Outputs:

Ensuring the maximisation of revenue by

• Ensuring accurate of coding

• Ensuring the correct application and interpretation of RSRT’s

• Participating in meetings and reporting forums to RSRT team and recommend corrective actions

• Monitoring insurance verification and workflow processes
  Ensuring effective management of quality outputs by

• Performing quality walkabout and implement corrective measures

• Implementing and monitoring quality improvement programmes

• Adhering to patient services escalation processes in order to achieve QMS targets

• Identifying, Escalating, monitoring and implementing corrective measures

• Investigating internal and external stakeholder complaints

• Ensuring the adherence to customer service standards
  Ensuring operational excellence by

• Monitoring submission of accurate accounts to funders

• Monitoring length of stay and level of care to funders of the wards cases and where operationally required specialised unit cases.

• Ensuring the compliance to LHE policies and managing authorisations and claim submissions, rejections and delays

• Ensuring the compliance to the management of outstanding authorizations as per schemes policies and procedures

• Ensuring compliance to service level agreements with internal and external stakeholders

• Ensuring all billing checks are closed by the relevant function areas
  Ensuring effective management of relationships with internal/external stakeholders by

• Attending to and resolving all internal/external stakeholder queries

• Building and maintaining relationships with internal stakeholders

• Ensuring effective communication and providing feedback to internal stakeholders

• Providing and facilitating training regarding RSRT contracts to the relevant internal stakeholders

• Escalating stakeholder concerns to relevant internal stakeholders

• Escalating doctor non-compliance in terms of RSRT framework to RSRT meetings

Requirements:

• 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.

• Current SANC registration

• Knowledge of hospital patient services and case management processes

• Knowledge and understanding of CPT & ICD coding

• Knowledge of private hospital industry and practices

• Computer proficiency

Competencies:

• Attention to detail

• Problem-solving, analysis and judgement

• Engaging diversity

• Business acumen

• Verbal & written communication skills

• Developing mechanical proficiency

• Building relationships

• Customer responsiveness

• Influencing skills

• Organising awareness

• Action orientation

• Ethical behaviour

More Information

•  JOB APPLICATION DETAILS 

  APPLICATION DETAILS
  Closing date: Interested candidates who meet the requirements are invited to apply by forwarding an application letter and a full comprehensive CV and certified certificates by 24th October 2025 to: Human Resource Manager Private Bag BR130 Gaborone Tel: +267 368 5600 Email: anna.kobo-gaborone@lifehealthcare.co.za Please consider your application as unsuccessful if you do not receive any feedback within 2 weeks from the closing date of this position advertised. Employees are advised to discuss their applications with their line managers prior to applying. Life Healthcare is an Equal Opportunity Employer. Making life better