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 discussion and resolution. ● Provide member care and education to patients with and without chronic conditions provident fund Requirements: ● Registered/ Enrolled Nurse ● Valid registration with SANC ● Minimum 2-3 years'
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
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 QUALIFICATIONS & EXPERIENCE Enrolled/Registered Nurse Minimum of 3-5 years of experience, with at least
transfer to rehabilitation, sub-acute, and private nursing facilities for quality and cost-effective services planning early in hospital admission.
transfer to rehabilitation sub-acute and private nursing facilities
Must be registered with the South African Nursing Council (SANC)
Experience
ReasearMinimum education (essential):
M.Communication Pathology in Audiology (or
management
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 legislation, protocols, processes, and systems. Education: A minimum of a Grade 12 certificate. Relevant
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 legislation, protocols, processes, and systems. Education: A minimum of a Grade 12 certificate. Relevant
ance
A relevant clinical or business related ND or Bachelor degree
as a primary point of contact for providers facilitating effective communication and collaborationurance
Minimum of 2 years of experience in clinical interventions
Experience in the PBM environment