utilisation management, education/training, and other clinically based activities as assigned, to coordinate care Communicates with the admitting facility to establish the clinical status of the patient. • Communicates updates stay and value to the hospital subject to the clinical guidelines and protocols of the company. • Communicates Updates the computer system with the member's clinical and demographic details. • Visits high cost members participates in discussions and presents cases at clinical meetings. • Prepares reports and case summaries
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)
deliver professional, commercially viable and quality clinic services in compliance with South African Nursing company standards. â–ª Manage a commercially viable clinic in line with company guidelines â–ª Provide lifestyle management screening tests â–ª Conduct “Well Baby” clinics, including health immunisations and baby health and reporting to ensure efficient running of the clinic as per company policy and processes â–ª Ensures and adhered to â–ª Manages, monitors and orders clinic services stock and equipment, along with prevention
deliver professional, commercially viable and quality clinic services in compliance with South African Nursing company standards. â–ª Manage a commercially viable clinic in line with company guidelines â–ª Provide lifestyle management screening tests â–ª Conduct “Well Baby” clinics, including health immunisations and baby health and reporting to ensure efficient running of the clinic as per company policy and processes â–ª Ensures and adhered to â–ª Manages, monitors and orders clinic services stock and equipment, along with prevention
of counselling and referrals Compiling monthly clinic reports Matric Professional Nursing Qualification Licence (a must) Computer Literacy (Knowledge of Clinic Sister would be an advantage) 5 years related experience
COMPETENCIES Computer Literacy. Demonstrate strong clinical skills with high attention to detail. Speak, read more experience as a Registered Nurse within a clinical environment. Rehabilitation experience is an advantage
negotiating annual increases for clients.
negotiating annual increases for clients. Ensure clinics comply with all legal requirements and internal reporting findings. Training of new employees on clinic protocols and procedures. Manage onboarding of of new client contracts. Ensure that clinics have necessary resources to deliver on expected services. various clinics as and when required. Coordination of staffing and leave management at various clinics. Recruiting
negotiating annual increases for clients. Ensure clinics comply with all legal requirements and internal reporting findings. Training of new employees on clinic protocols and procedures. Manage onboarding of of new client contracts. Ensure that clinics have necessary resources to deliver on expected services. various clinics as and when required. Coordination of staffing and leave management at various clinics. Recruiting
the efficient operation of the dispensary and the clinic and to ensure service excellence by leading and financial management, focus on core dispensary and clinic targets, management of expenses and proactively To ensure integration and partnership with the clinic and healthcare aisle resulting in a full offering integration between the store operation, pharmacy and clinic teams. To drive a high performing business culture