JOB PURPOSE The role of a Member Care Clinical Consultant (Pre-Authorisations) involves ensuring that within available benefits as per scheme rules, clinical protocols and funding guidelines. Loading of authorisations call. Strict adherence to benefits, scheme rules, clinical protocols and funding guidelines across all services services and authorisation categories. Clinical Risk Management to reduce the risks associated with hospitals NRPL, PMB conditions and clinical protocols Thorough, well-grounded clinical knowledge of the pre-authorisation
Working in a clinical environment and interacting with both clinical and non-clinical and academic colleagues and organization of data (user studies) User and Clinical Studies: 60%. Conducting user and usability engineering engineering studies, RETSPL studies, and clinical validation studies. Managing all aspects of the research team with required documentation. Investigating clinical & regulatory requirements and providing feedback
Working in a clinical environment and interacting with both clinical and non-clinical and academic colleagues and organization of data (user studies) User and Clinical Studies: 60%. Conducting user and usability engineering engineering studies, RETSPL studies, and clinical validation studies. Managing all aspects of the research team with required documentation. Investigating clinical & regulatory requirements and providing feedback
organisation based in Pretoria is looking for a Clinical Quality Assurance Coach. This is an equal opportunity medical scheme and insurance industries. Position: Clinical Quality Assurance Coach Reporting to: Team Leader: ensuring that the team maintains high standards of clinical quality and compliance. This role involves monitoring pre-authorisation cases to ensure compliance with clinical guidelines and policies. Monitor calls and interactions group coaching sessions to staff to enhance their clinical knowledge and skills. Develop and deliver training
Coordinator will render active disease management, clinical care support, coaching and health education services Disease List (CDL) conditions by integrating the clinical care and self-management aspects for all medium beneficiaries. He/ She will be an integral part of the clinical and disease management teams and will assist, epidemiology, clinical management, conditions, and self- management of chronic conditions into clinical practice manage the patients at risk. Provide assistance to clinical case management and preauthorisation team members
ensuring that the team maintains high standards of clinical quality and compliance. This role involves monitoring pre-authorisation cases to ensure compliance with clinical guidelines and policies. Monitor calls and interactions group coaching sessions to staff to enhance their clinical knowledge and skills. Develop and deliver training training programs focused on improving clinical quality and adherence to guidelines. Offer continuous feedback within the healthcare industry. SKILLS Strong clinical knowledge and understanding of medical terminology
within available benefits as per scheme rules, clinical protocols and funding guidelines. ● Loading of ● Strict adherence to benefits, scheme rules, clinical protocols and funding guidelines across all services services and authorisation categories. ● Clinical Risk Management to reduce the risks associated with NRPL, PMB conditions and clinical protocols ● Thorough, well-grounded clinical knowledge of the pre-authorisation
we collaborate with our valued client to seek a Clinical Pre-Authorisation Consultant. We are looking for Verification: Accurately capture and validate clinical information, including ICD-10 and item codes. applied before approving benefits. Clinical Analysis: Provide clinical interpretation and analysis of medical
we collaborate with our valued client to seek a Clinical Pre-Authorisation Consultant. We are looking for Verification: Accurately capture and validate clinical information, including ICD-10 and item codes. applied before approving benefits. Clinical Analysis: Provide clinical interpretation and analysis of medical
targeted research into local and international clinical guidelines and funding policies. Critical review practice. Assist in the management and monitoring of clinical cost targets Assist in developing and maintaining Assist the Medical Advisory Services in providing clinical support to Healthcare Management and the Scheme's society and groups and other forums as required). Clinical review of hospital and provider efficiency and