Clinical Case Manager

National Health Group is seeking a clinically experienced and detail‑oriented Clinical Case Manager to support the management of medical insurance and selected medical aid cases.

This role is primarily focused on medical insurance case management, including hospital admissions, planned procedures, day‑case procedures, authorisation support, provider liaison, claims support, shortfall communication and member guidance. The role also involves medical aid cases with limited cover, primarily at Prescribed Minimum Benefit level of care.

The ideal candidate should be comfortable working in a managed care environment where clinical insight, clear communication, accurate documentation and empathetic member support are essential.

Key Responsibilities

• Managing emergency and planned casualty and hospital admission cases in line with NHG protocols, benefit rules and policy limitations.
• Supporting authorisation and claims processes by obtainin...