Permanent
Finance/Accounting - Finance/Accounting Management Port Elizabeth 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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Eastern Cape is an important market for jobs and professional roles in South Africa. The Eastern Cape includes Gqeberha automotive suppliers, Mthatha public-sector posts, and rural education and health vacancies. Some roles are only viable if you can relocate or have reliable transport. Automotive components, education, healthcare, and agriculture drive much of the hiring. Graduate programmes with national employers sometimes recruit from Nelson Mandela Bay. Long distances between towns mean remote or hybrid roles are attractive when available. If a role is on-site, explain how you will handle daily travel or relocation.
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