Position Purpose

To lead and manage a team of professionals responsible for hospital pre‑authorisations and/or case management, ensuring accurate, clinically appropriate, and cost‑effective decision‑making. The role ensures adherence to clinical guidelines, medical necessity criteria, and effective clinical risk management, while optimizing patient outcomes and resource utilisation.

Experience

Minimum of 2 to 3 years relevant managed care, health risk and clinical customer service within Medical Scheme Administration Industry or similar. Previous exposure in managing a Clinical team will be advantageous.

Qualifications

• Nursing qualification with SANC registration/enrolment (mandatory)
• Strong knowledge of scheme rules, coding, and managed care protocols

Accountabilities

Compliance and Risk Management

• Analyse and provide client specific and business reports
• Defi...