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
health risk and clinical management services, has a permanent vacancy available for a Clinical Quality Assurance 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.
Bestmed is a non-profit, mutual medical scheme registered with the Council for Medical Schemes. We have been providing healthcare to the lives of South Africans for over 60years. Bestmed strives to be an employer of choice by: • creating a Personally Ours culture where we can all contribute in our
Pretoria, has a Permanent vacancy for a Member Care Clinical Consultant (Pre-Autorisation).
Job
Purpose:
The role of a Member Care Clinical Consultant (Pre-Authorisations) involves ensuring
within available benefits as per scheme rules, clinical protocols and funding guidelines.
urance
Minimum of 2 years of experience in clinical interventions
Experience in the PBM environment
(SAPC)
Minimum of 2 years of experience in clinical interventions
Experience in the PBM environment Qualifications:
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 patients at risk.