Hospital Benefit Management

4 weeks ago


Pretoria, South Africa Medpharm Recruitment Full time

A reputable Medical Aid is seeking a Case Manager to deliver cost-effective managed healthcare service to accomplish member satisfaction and to deliver affordable managed healthcare services.

**Requirements**:

- Grade 12
- BCur Degree or Registered Nurse Diploma in Nursing (SANC)
- Minimum 5 years experience as a Nursing Practitioner
- Minimum 1 year experience gained in the Medical Aid Fund industry
- Experience within a Hospital Benefit Management (HBM) team
- Excellent clinical knowledge of Pre-Authorisation of hospital admissions and Case Management of hospital cases
- Knowledge of the current coding structures in the SA Healthcare environment (ICD10 / CPT4, NRPL and PMB Conditions)
- Excellent communication skills
- Ability to speak both English and Afrikaans fluently
- Criminal and Credit Clear
- South African born citizen

**Job Types**: Full-time, Permanent

Ability to commute/relocate:

- Pretoria, Gauteng: Reliably commute or planning to relocate before starting work (required)

Application Question(s):

- Which Medical Aid Company have you worked for before/currently?
- Do you speak both English and Afrikaans fluently?
- What is your minimum salary expectation? (Before deductions) Bearing in mind this role offers a Pension Fund and Medical Aid which forms part of the Cost to Company.

**Education**:

- Diploma (preferred)

**Experience**:

- Pre-Authorisation or Case Management: 1 year (required)

License/Certification:

- SANC (required)



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