Clinical Consultant: Oncology

2 weeks ago


Centurion, Gauteng, South Africa PPS Recruitment Full time

Job Advert Summary:

An exciting opportunity for an analytical and attention-to-detail Pre

Minimum Requirements:

  • Nursing qualification.
  • Emergency Services qualification or any other Clinical/Medical qualification
  • Previous exposure in a Managed Healthcare Call Centre
  • 10 years Pre-Auth experience if no clinical qualification
  • Previous exposure in Renal Dialysis, Oncology and/or Psychiatric environment would be most preferred.
  • Exposure to Theatre and/or ICU in a private hospital will be an added advantage.
  • Sound knowledge of the

Coding Systems:
ICD10 & CPT4 Principles and sound knowledge of the Medical Aid Industry, Rules & Regulations, ISO and other related legislation

  • Excellent business writing & communication skills with exceptional telephone etiquette.
  • Must have strong organisational awareness to anticipate the impact of actions on other groups.
  • Time Management & good administration skills
  • Effective conflict resolution skills and the ability to work under pressure.
  • Must be a strong team player and results driven.
  • Computer literacy (MS Office and Medical Administration system)

Duties and Responsibilities:

  • Ensuring successful & smooth Pre-Authorisation and case management process on all Oncology cases.
  • Ensure adherence to Scheme Rules on all Oncology authorisations requests.
  • Effective handling of internal/external clinical queries, communicating with members and service providers in order to address all clinicalrelated matters.
  • Compile & submit detailed feedback to the Scheme on costs and patient progress when requested/required.
  • Respond effectively to internal and external queries/problems regarding clinical matters/claims/issues relating to clinical information per request from members/service providers/other employees using the system/telephone/Scheme Rules in order to address queries/problems of clients satisfactorily.
  • Create/monitor alternative treatment plans using the physician's motivation letter/Benefit Structure/Rules of the Scheme/System/Telephone/Fax machine in order to ensure the most costeffective treatment of cases.
  • Receive/evaluate/adjudicate/authorise/capture requests from members for hospitalisation/Oncology Cases, using telephone/System/Rules of the Scheme/SOP in order to manage the hospital utilization by members in a costeffective manner.
  • Refer appeals to the Medical Advisor in order to make a final decision.
  • Review/evaluate the hospital authorisations/Oncology Cases using telephone/MS Outlook/Fax machine/Rules of the Scheme/clinical knowledge in order to update pending and rejected authorisations.
  • Communicate with members/service providers using telephone/fax machine/MS Outlook in order to address hospital utilisation matters

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