Care Escalations Specialist

AfroCentric Group; Wes-Kaap; On-site; ZAR 420,000 - 660,000; Full time

Job summary

AfroCentric Group is seeking a healthcare professional to deliver personalised clinical care coordination across the patient journey. You will manage and validate authorisation requests, coordinate care journeys, and engage with members and providers to ensure high-quality service.

The role focuses on holistic, accessible care delivery, adherence to scheme rules, and leveraging digital platforms for self-service. Applicants should have relevant registration and several years in managed care.

Qualifications

• Registered healthcare professional with active registration
• Minimum 4–6 years managed healthcare experience
• 2 years knowledge of managed care programmes and rules

Responsibilities

• Provide personalised clinical care coordination and support to members throughout their healthcare journey
• Manage clinical service requests across channels with timely resolution
• Coordinate patient care journeys for holistic, accessible delivery
• Assess and validate authorisation requests per scheme rules and guidelines
• Engage with members, providers and stakeholders to offer professional clinical support
• Educate members on available benefits and self-service platforms
• Resolve queries and escalations per policies and service standards
• Build relationships with providers, members and internal teams to support quality delivery
• Monitor clinical cases and ensure appropriate follow-up and continuity of care
• Contribute to process improvements to enhance efficiency and customer experience

Skills

Clinical care coordination

Customer service

Stakeholder engagement

Regulatory knowledge

Job description

Position Purpose:

Deliver and enable excellence in all service moments to all stakeholders. Personalised clinical servicing through the Omni channel experience focusing on the overall care quality of interaction between our customers and the brand. Providing holistic care that is personalised and accessible, managing the care journey end to end. Committing to our service care charter striving to continuously make a positive difference.

Experience:

4 – 6 years Managed Healthcare Experience. 2 years Comprehensive knowledge of the Managed Care programmes, scheme rules and operational systems Experience

Qualifications:

Registered Pharmacist/Nurse or other healthcare professional. Relevant and active registration with regulatory body

Position Specific Outputs and generic objectives:

• Provide personalised clinical care coordination and support to members throughout their healthcare journey, ensuring a seamless and positive service experience.
• Manage clinical service requests across all service channels, ensuring timely resolution and high-quality customer service.
• Coordinate and manage patient care journeys, ensuring holistic, accessible and customer-centric care delivery.
• Assess, manage and validate authorisation requests in accordance with scheme rules, clinical guidelines and operational requirements.
• Facilitate personalised clinical interventions and case management to improve member health outcomes and care experiences.
• Engage with members, healthcare providers and other stakeholders to provide accurate, consistent and professional clinical support.
• Educate members and stakeholders on available healthcare benefits, processes and self-service digital platforms.
• Resolve customer and stakeholder queries, complaints and escalations in line with organisational policies and service standards.
• Build and maintain effective relationships with healthcare providers, members and internal stakeholders to support quality service delivery.
• Monitor and manage clinical cases proactively, ensuring appropriate interventions, follow-up actions and continuity of care.
• Ensure compliance with healthcare legislation, regulatory requirements, governance frameworks and organisational policies.
• Support the achievement of departmental service levels, quality measures and operational performance targets.
• Identify opportunities for process improvement and contribute to initiatives that enhance operational efficiency and customer experience.
• Collaborate effectively with multidisciplinary teams to support integrated healthcare management and knowledge sharing.
• Contribute to departmental cost-saving initiatives while maintaining high-quality clinical and customer service standards.
• Act as a brand ambassador by consistently demonstrating AfroCentric values and strengthening stakeholder trust and loyalty.

The shortlisting process will only start once the application due date has been reached. The time taken to complete this process will depend on how far you progress and the availability of line managers.

Our Commitment to Transformation

AfroCentric is committed to transformation and embracing diversity. Our Employment Equity plan and targets will be considered as part of the recruitment process. This commitment is what drives us to achieve a diverse workplace with employment equity as a key goal to create an inclusive workforce, representative of the demographics of our society as well as people with disabilities.

Should you not hear from us within a month of applying, consider your application unsuccessful.