Clinical Care Navigator for Escalations

AfroCentric Group; Wes-Kaap; In loco; ZAR 420.000 - 660.000; Tempo pieno

Descrizione del lavoro

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.

Competenze

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

Mansioni

• 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

Conoscenze

Clinical care coordination

Customer service

Stakeholder engagement

Regulatory knowledge

Descrizione del lavoro

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.