Position Purpose : To manage the spending of member funds by means of clinical interventions and managed care protocols.

Experience: At least 3 years general medical and surgical nursing experience in the private sector. ICU training and/or at least 1 year ICU nursing experience and 1 year hospital case management experience will be advantageous. In conjunction with above, at least 18 months hospital pre-authorisation experience.

Qualifications: Professional Registered Nurse with valid up to date registration with the South African Nursing Council (MANDATORY REQUIREMENT)

KEY PERFORMANCE AREAS

Member Assessment and Care Coordination

• Review member medical records, treatment plans, and claims to assess care needs.
• Coordinate care with healthcare providers, including doctors, hospitals, and allied health professionals.
• Develop and implement individualised c...