Case Management experience – Hospital / Funder Clinical Nursing / managed healthcare experience ICD-10 purpose of this position: The Case Manager utilising clinical knowledge, experience and patient acuity scoring Conducting ward rounds on identified patients to obtain clinical information from the patient files Liaising with hospitalisation Ensure accurate, specific and comprehensive clinical coding Timeous, effective communication and follow-up
qualification and/or Case Management qualification Diverse clinical nursing experience Case Management experience purpose of this position: The Case Manager utilising clinical knowledge and expertise, mitigates financial risk Responsibilities: Responsible for application of clinical knowledge in justifying patient hospitalisation hospitalisation Ensure accurate, specific and comprehensive clinical coding Timeous, effective communication and follow-up
Requirements: Registered with SANC Clinical qualification Registered Nurse / Professional Nurse or qualified qualified Paramedic Minimum of 3 years in a clinical role Experience in Theatre and or ICU; Medical aid coding; and case management processes Application of clinical codes and finalisation thereof (Level 3 coding)
have a strong background in case management and clinical coding within a private hospital setting, we want services to ensure optimal outcomes - Utilize clinical coding expertise to ensure accurate billing and Enrolled Nurse with proven case management and clinical coding experience of at least 3-5 years - Private
This role will play a key role in bringing deep clinical understanding and judgment in benefit-risk assessments role will also ensure projects adhere to Good Clinical and Pharmacovigilance Practice and Regulatory interpretation of safety information collected from pre-clinical through to post-marketing, including medical review Investigator's Brochures, Clinical Study Protocol, Study Safety Plans, and Clinical Safety reports. Reviewing interpretation of safety information collected from pre-clinical through to post-marketing, including medical review
This role will play a key role in bringing deep clinical understanding and judgment in benefit-risk assessments role will also ensure projects adhere to Good Clinical and Pharmacovigilance Practice and Regulatory interpretation of safety information collected from pre-clinical through to post-marketing, including medical review Investigator's Brochures, Clinical Study Protocol, Study Safety Plans, and Clinical Safety reports. Reviewing interpretation of safety information collected from pre-clinical through to post-marketing, including medical review
ALMA-Clinics” (Alma), is a Primary healthcare (PHC) Nurse-led Medical Technology Clinic Network that Ethics/conduct and standards related to primary clinical care; Identifies ethical dilemmas and make a critical assessment, diagnosis and management of the patient. Clinical Assessment Conducts a comprehensive and holistic investigation results to confirm the final diagnoses. Clinical Diagnosis Interprets history and physical examination consultation with the supervising Clinical Associate and Doctor. Clinical Treatment Discusses with patient
Provide clinical inputs on ex-gratia funding requests Open, review and resolve all clinical queries and and assessments through providing a clinical decision or requesting more information where required Implement authorisation and claiming is facilitated Provide clinical training / support to identified stakeholders Knowledge and application of clinical principles and processes Knowledge of clinical and funding protocol development development Clinical research and assessment Knowledge of scheme rules and contractual negotiations Skill:
Provide clinical inputs on ex-gratia funding requests Open, review and resolve all clinical queries and and assessments through providing a clinical decision or requesting more information where required Implement authorisation and claiming is facilitated Provide clinical training / support to identified stakeholders Knowledge and application of clinical principles and processes Knowledge of clinical and funding protocol development development Clinical research and assessment Knowledge of scheme rules and contractual negotiations Skill:
medical insurance space is seeking a Medical Claims Clinical Auditor to join their team based in Port Elizabeth hospital nursing experience. Previous exposure to clinical auditing is highly advantageous. Be available Responsibilities Internal Process: Apply scheme rules, clinical policies and protocols to funding. Action allocated case managers for resolution. Act as clinical support to non-clinical hospital claim auditors in terms of of hospital tariff applications and clinical guidance (e.g. procedures, devices and drug utilization)