Registered Nurse – Managed Healthcare (3-month Temp)

About the role

Our client, a healthcare insurance provider, is seeking a registered nurse with a valid SANC registration for a three‑month temporary position. The role involves delivering managed healthcare services, supporting call‑centre operations, and ensuring high‑quality patient care.

Key responsibilities

• Provide cost‑effective managed healthcare services while maintaining quality patient care.
• Deliver call‑centre assistance to enhance member satisfaction and resolve queries.
• Conduct clinical assessments and triage members to appropriate levels of care.
• Pre‑authorise GP consultations based on clinical evaluations.
• Refer members to network providers such as Intercare, Pharmacy Nurse Clinics, and Reality Wellness.
• Implement clinical risk‑management strategies to optimise outcomes.
• Audit GP claims for accuracy and compliance with ICD‑10 coding standards.
• Maintain compliance with Service Level Agreements and uphold customer service standards.

Required profile

• Matric Certificate.
• Registered Enrolled Nurse or Enrolled Nursing Auxiliary with the South African Nursing Council (SANC) and active membership.
• 2–3 years of experience in a healthcare managed‑care role.
• Strong clinical and risk‑management knowledge.
• Understanding of South African health industry regulations, benefits, and environment.

Required skills

• Familiarity with ICD‑10 coding and related modifiers.
• Knowledge of RPL tariff structures.