Posted 1 year ago

Together with our client, we are recruiting for a Clinical Case Manager (Call Centre) in Pretoria.  The Candidate must be a Registered Nurse with SANC and have at least two years’ experience in the private healthcare sector.  Previous experience working at a Medical Aid Scheme would be an advantage.

Duties and Responsibilities

  • Receive applications for all services which require pre-authorisation.
  • Handling of telephonic authorisations, hospital, radiology and specialist referrals on the pre-authorisation call centre.
  • Capture clinical information and verify the information, including the applicable ICD-10 and item codes.
  • Confirm membership status & available benefits on the system before authorisation can be granted.
  • Validate and evaluate special pre-authorisation requests.
  • Ensure that the correct codes are used before benefits are approved.
  • Clinical interpretation and analysis of medical reports and/or doctor’s motivation.
  • Provide correct applicable information in respect of scheme rules, benefits & approvals in respect of all services requiring to patients and service providers.
  • Approve benefits accurately according to the benefits per benefit option and strictly according to the protocols to reduce the Scheme’s risk in respect of benefits.
  • Accurate and complete capturing of all relevant information as well as approved documents on the appropriate operational systems.
  • Deliver a high-quality service to the members and service providers.
  • Keep abreast of amendments to scheme rules, benefit options, legislation, protocols, processes and systems

Job requirements

  • Matric
  • A completed degree/diploma as a registered nurse and must be registered with SANC.
  • Two year’s relevant experience in a private hospital.
  • Comprehensive knowledge of the Medical Schemes Act.
  • Sound knowledge of CPT-4 & ICD-10 codes.


  • Technical and professional knowledge and skills;
  • Managing work;
  • Customer focus;
  • Good verbal and written English communication skills as well as proficiency in understanding Afrikaans spoken and written communication;
  • Computer literate.
  • Must work well with people, and be able to handle conflict situations


  • Market-Related depending on experience


  • Pension Fund
  • 13th cheque
  • Medical Aid

Total Cost to Company of R 318 946.00 to R 361 186.00 (Neg) per Annum

If you meet the above-mentioned requirements please send your CV, Qualifications and SANC registration to with REF: Clinical Case Manager

Job Features

Job CategoryCall Centre, Registered Nurse

Apply Online