HIV and Wellness Case Manager: To provide administrative support for HIV, Preventative care, Wellness interventions and Dialysis (in order to manage and authorise Wellness and HIV benefits, applying evidence-based medicine principles and considering affordability to the different benefit options)

Candidate Requirements:

B Cur Degree / Diploma in Nursing
Thorough, well-grounded clinical knowledge of Pre Authorization of hospital admissions and Case Management of hospital cases in order to take cost-effective and appropriate decisions in evaluating treatment, LOS and LOC.
Knowledge of the current coding structures in the South African Health Care environment i.e. ICD10’s, CPT4, NRPL, and PMB conditions, protocols and Scheme rules
Understanding of the Medical Scheme Rules and Benefit Options.
Understanding of the medical scheme industry
Experience in the medical funding industry
Minimum 2-5 years experience in medical aid environment - NB
Excellent communication skills and independent, knowledgeable candidate