Finance/Accounting - Finance/Accounting Management Gauteng FULL TIME Job Summary Requirements: * Grade 12 / Matric is relevant * General Nursing Diploma or Degree * Must be registered with SANC (South African Nursing Council) as a Registered / Professional Nurse * A minimum of 3 years’ experience in a managed care/case management environment * A minimum of 3 years’ clinical experience within a private hospital is essential (ICU and theatre experience is advantageous) * Prior leadership experience is advantageous * Clinical Auditing experience is advantageous * Good understanding of the Medical Scheme industry * Proficient in Microsoft Office Responsibilities: * Lead and supervise the Case Management and Clinical Claims Auditing teams, ensuring achievement of key performance indicators (KPIs) and service delivery  standards. * Ensure compliance with all company HR policies and procedures. * Provide ongoing training, guidance, and communication to staff regarding benefits, tariffs, scheme rules, and organisational policies and procedures. * Support the resolution of complex and escalated case management and clinical audit queries. * Manage and investigate complaints received from the Council for Medical Schemes (CMS) and liaise with Fund Managers to ensure effective resolution. * Monitor, analyse, and report on weekly operational and performance metrics, implementing corrective actions and continuous improvement initiatives where required. * Assist Fund Managers with the compilation of information and preparation of reports and presentations for meetings and stakeholder engagements. * Review and analyse workflow processes to identify efficiencies, enhance productivity, and ensure process relevance and effectiveness. * Ensure all operational, audit, and performance reports are reviewed, validated, and appropriately actioned within agreed timelines. Please note that if you do not receive a response within 2 weeks, your application has been unsuccessful. Headhunters Recruiter

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