Specialist Case Manager (Talent Pool)

Afrocentric Group; Durban; On-site; ZAR 250 000 - 350 000; Full time

Job summary

A leading healthcare provider in Durban seeks a qualified healthcare professional to manage care service requests and authorize clinical cases. The ideal candidate will have experience in healthcare operations and specialized clinical experience. Responsibilities include maintaining customer satisfaction and managing clinical interventions. The role requires a registered nursing qualification and offers opportunities to engage with stakeholders in a dynamic environment.

Qualifications

• 2-3 years of operational experience in healthcare preferred.
• Strong understanding of health legislation and regulatory guidelines.
• Ability to manage clinical cases and drive brand loyalty.

Responsibilities

• Manage care service requests and educate stakeholders.
• Handle authorizations with empathy and understanding.
• Provide excellent customer experiences and ensure quality standards.

Skills

Managed Healthcare Operations experience

Specialised Clinical experience

Advanced Customer service

Knowledge of Health Care Industry

Education

Registered Nursing Qualification, NQF level 7

Registered Nursing Qualification, NQF level 6

Tools

Basic Microsoft Suite

Basic channel experience

Job description

Purpose

Deliver and enable excellence in all service moments to all stakeholders (Members, Providers, Employer groups, Intermediaries, Schemes). 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.

Experience

Managed Healthcare Operations experience Operational 2 years Advantageous

Specialised Clinical experience. (e,g, ICU, Neonatal, Renal, Psch, etc) Operational 2 - 3 years Essential

Qualifications

Bachelors Degree (3 years) / NQF level 7(Registered Nursing Qualification, plus registration with SA Nursing Council) Advantageous

Diploma / NQF level 6(Registered Nursing Qualification, plus registration with SA Nursing Council)

Position Specific KPA

• Manage Care Service Requests — Servicing all key stakeholders in the moment across all servicing channels as required until the clinical service request has been resolved.
• Educating stakeholders on self-help digital servicing tools. Connecting with your customers (all stakeholders) across all channels, enabling an intuitive experience bringing across our brand authentically. Providing a seamless, progressive and holistic approach, understanding the customer’s needs.
• Manage authorizations — Manage and or validate the customer’s authorizations needs with care, understanding and empathy. Caring holistically for the patient journey.
• Manage Cases — Manage clinical cases enabling a holistic personalised intervention. Caring holistically for the patient and their support structure journeys.
• Manage Excellent Experiences — Provide accurate and consistent information, meeting all quality standards and measures. Deliver excellence in customer satisfaction. Strive to identify areas of improvement and sharing of ideas with your team. Collaborate with all teams to enable peer to peer learning
• Drive Brand Loyalty — Being a brand ambassador, allowing the brand presence to be felt as an extension of the experience.

Knowledge

• Advanced Health Care Industry
• Advanced Good understanding of the Health Care Environment and Facilities
• Advanced Health legislation and regulatory
• Basic Application of service processes
• Advanced Customer service
• Advanced Customer preferences and personality styles

Technical

• Basic Microsoft Suite
• Basic use of technology
• Basic channel experience

Turnaround Time

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.