Job Description
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...