Experience: 2 to 4 Years in similar position

Managed Care organisation seeks to employ an experienced Registered Nurse Case Manager in Clinical Benefit Management. Responsible for management on progress regarding long term & high cost cases for hospitalised & home care patients.

Key Requirements:

  • Registered Nurse with active SANC registration
  • 2 to 4 years experience in Clinical Benefit Management in Managed Care /Medical Scheme sector essential
  • Responsible for high cost long term cases
  • Expertise in clinical guidelines
  • Expertise in ICD10 codes and various clinical coding/ CPT Coding
  • Good understanding regarding scheme rules regarding tariffs and discounts in order to negotiate accordingly
  • Maintaining progress regarding long term & high cost cases of hospitalised & home care patients
  • Follow due processes on case escalations processes regarding cases requiring participation from internal Senior Health Professionals
  • Responsible for handling calls and enquiries
  • Managing services and care to the minimise member’s risk
  • Identifying hospitalised members for transfer to step down facilities etc to remain cost effective
  • Communicate clinical funding recommendations via hospital authorisation notes to doctor, member, suppliers, and service providers
  • Valid Drivers License and own vehicle
  • Coordinate visits as and when required

To apply submit application to response “at” [URL Removed]

Supporting documentation required:

  • Copy of Matric Certificate
  • Copy of Qualification as Registered Nurse
  • Copy of SANC Registration
  • Copy of valid Drivers License
  • Comprehensive CV detailing your Clinical Risk Management experience

Desired Skills:

  • 2 to 4 years experience in Clinical Benefit Management in Managed Care /Medical Scheme sector essential

Desired Work Experience:

  • 2 to 5 years

Desired Qualification Level & Accreditations:

  • Diploma
  • South African Nursing Council

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