Current jobs related to Member Care Clinical Consultant - Pretoria - H2R Africa

  • Member Clinical Associate

    5 months ago

    Pretoria, South Africa iMedrecruit Full time

    **Member Clinical Consultant (Pre-authorisations), Pretoria** Our client, focusing on a risk and clinical assessment offering, is requiring a Member Clinical Consultant. **Roles and Responsibilities (but not limited to)**: - Attend to incoming calls from healthcare service providers and members/ beneficiaries. - Verification of the eligibility of cover...

  • Member Clinical Associate, Pretoria

    5 months ago

    Pretoria, South Africa iMedrecruit Full time

    About the job Member Clinical Associate, Pretoria **Member Clinical Consultant (Pre-authorisations), Pretoria** Our client, focusing on a risk and clinical assessment offering, is requiring a Member Clinical Consultant. **Roles and Responsibilities (but not limited to)**: - Attend to incoming calls from healthcare service providers and members/...

  • Pre-authorisation Consultant

    5 months ago

    Pretoria, South Africa care force Full time

    **Description**: Position: Coordinator: Member Care (Pre-authorisations) Reporting to: Contact Centre Operational Manager Location: On-site at the Head Office, Pretoria - **You will be required to work shifts between 7h00 and 19h00 (Monday to Sunday)**_ **Qualifications**: - Registered/ Enrolled Nurse - Valid registration with SANC **Skills and...

  • Clinical Technologist

    2 days ago

    Pretoria, South Africa National Renal Care Full time

    National Renal Care is a leading comprehensive kidney disease management provider in South Africa. Our organisation fosters a collaborative work environment where compassion, digital innovation, and clinical excellence merge to deliver high-quality care to individuals with compromised organ function. We are looking for a qualified individual to fill the...

  • Co--ordinator Member Care

    5 months ago

    Pretoria, South Africa H2R Full time

    Gauteng, Tshwane (Pretoria) - To be discussed - To be discussed Monthly Cost To Company (Market related) Our client, in the Medical Industry has a permanent vacancy in for a Co-ordinator: Member Care (Pre-Autorisation). To qualify for this position you must be: - Registered/ Enrolled Nurse. - Valid registration with SANC. This position will require you...

  • Senior Manager Clinical Consulting Services

    5 months ago

    Pretoria, South Africa Vivo Group Full time

    **SENIOR MANAGER: CLINICAL CONSULTING SERVICES** The purpose of the job is to oversee the provision of Clinical services, administer the Prescribed Minimum Benefits (PMB) portfolio to ensure medical scheme members are protected and their entitlements are guaranteed, and to develop and implement the Prescribed Minimum Benefits regulation strategy. As a...

  • Case Manager

    5 months ago

    Pretoria, South Africa care force Full time

    Our client, a managed care organisation based in Pretoria is looking for a Case Manager. This is an equal opportunity organisation with various businesses and/ or subsidiaries that service clients in the medical scheme and insurance industries. Position: Case Manager (Member Management) Reporting to: Senior Specialist Clinical Management Location: On-site...

  • Senior Manager: Clinical Consulting Services

    6 months ago

    Pretoria, South Africa Nambiti Technologies Full time

    We are recruiting for a Senior Manager Clinical Consulting Services. - Driving the implementation of Clinical Consulting Services planned activities and projects: - Oversee the functioning of the Clinical Consulting Services sub-division by managing the sub-division projects and day to-day function of the Clinical unit including performance management,...

  • Primary Health Care Clinic Manager

    2 weeks ago

    Pretoria, Gauteng, South Africa Dis-Chem Pharmacies Full time

    Key Responsibilities:The successful candidate will be responsible for managing a Primary Health Care Clinic within a pharmacy, ensuring the clinic operates efficiently and effectively.Key Requirements:Grade 12 Matric and a tertiary qualification in General NursingDiploma in Midwifery or a related fieldRegistration with the South African Nursing Council...

  • Senior Manager Clinical Consulting Services

    5 months ago

    Pretoria, South Africa Thusa Batho Labour Solutions Full time

    The purpose of the job is to oversee the provision of Clinical services, administer the Prescribed Minimum Benefits (PMB) portfolio to ensure medical scheme members are protected and their entitlements are guaranteed, and to develop and implement the Prescribed Minimum Benefits regulation strategy. As a Senior Manager: Clinical Consulting Services you will...

  • Pre Authorisations Consultant

    5 months ago

    Pretoria, South Africa iMedrecruit Full time

    About the job Pre Authorisations Consultant **Pre-authorisations Consultant, Pretoria** Our client, focusing on a risk and clinical assessment offering, is requiring a Pre-Authorisations Consultant. **Roles and Responsibilities (but not limited to)**: - Attend to incoming calls from healthcare service providers and members/ beneficiaries. - Verification...

  • Senior Manager: Clinical Consulting Services

    5 months ago

    Pretoria, South Africa Future Africa Consulting (Pty)Ltd Full time

    The purpose of the job is to oversee the provision of Clinical services, administer the Prescribed Minimum Benefits (PMB) portfolio to ensure medical scheme members are protected and their entitlements are guaranteed, and to develop and implement the Prescribed Minimum Benefits regulation strategy. As a Senior Manager: Clinical Consulting Services you will...

  • ▷ [3 Days Left] Relocate to the UK - Consultant Clinical Haematologist (Doctor)

    3 weeks ago

    Pretoria, South Africa Sanctuary Personnel Ltd Full time

    Sanctuary International, a dedicated and award-winning recruitment agency with a TrustPilot score of 4.9/5 and nearly 1000+ reviews, is currently looking for an experienced and dedicated Consultant Clinical Haematologist to work in Carlisle, UK, on a full-time basis. The salary for this permanent Clinical Haematologist Consultant job is £105,504 to...

  • Clinical Advisor

    5 months ago

    Pretoria, South Africa The Aurum Institute Full time

    Work Description_ The Clinical Advisor is responsible for providing clinical advice and strategic direction to the to the support district/s and the appropriate internal and external clinical staff. They will building capacity among HCW to strengthen the TB HIV response and ensure clinical governance standards at all times. The position will assist the...

  • Clinical Advisor

    5 months ago

    Pretoria, South Africa The Aurum Institute Full time

    Work Description The Clinical Advisor is responsible for providing clinical advice and strategic direction to the to the support district/s and the appropriate internal and external clinical staff. They will building capacity among HCW to strengthen the TB HIV response and ensure clinical governance standards at all times. The position will assist the...

  • Stock Controller/ Health Care Worker- Nrc Montana

    6 months ago

    Pretoria, South Africa National Renal Care Full time

    National Renal Care is a leading comprehensive kidney disease management provider in South Africa. Our organisation fosters a collaborative work environment where compassion, digital innovation, and clinical excellence merge to deliver high-quality care to individuals with compromised organ function. At National Renal Care, we are committed to being an...

  • Stock Controller/ Health Care Worker- Nrc Montana

    6 months ago

    Pretoria, South Africa National Renal Care Full time

    **Job Ref #**: 00749 **Industry**: Pharmaceutical And Medical/Healthcare **Job Type**: Permanent **Salary**: Market Related Description: National Renal Care is a leading comprehensive kidney disease management provider in South Africa. Our organisation fosters a collaborative work environment where compassion, digital innovation, and clinical excellence...

  • Case Manager

    6 months ago

    Pretoria, South Africa iMedrecruit Full time

    About the job Case Manager (Member Management) 12 Month FTC - Pretoria **Case Manager (Member Management) 12 Month FTC - Pretoria** Our client, focusing on a risk and clinical assessment offering, is requiring a Case Manager (Member Management). **Requirements (but not limited to)** - Perform Clinical coding in accordance with CPT and ICD requirements and...

  • Assistant Unit Leader- NRC Arcadia

    3 weeks ago

    Pretoria, South Africa National Renal Care Full time

    National Renal Care is a leading comprehensive kidney disease management provider in South Africa. Our organisation fosters a collaborative work environment where compassion, digital innovation, and clinical excellence merge to deliver high-quality care to individuals with compromised organ function. We are looking for a qualified individual to fill the...

  • Unit Leader- NRC Akasia

    3 weeks ago

    Pretoria, South Africa National Renal Care Full time

    National Renal Care is a leading comprehensive kidney disease management provider in South Africa. Our organisation fosters a collaborative work environment where compassion, digital innovation, and clinical excellence merge to deliver high-quality care to individuals with compromised organ function. We are looking for a qualified individual to fill the...

Member Care Clinical Consultant

4 months ago

Pretoria, South Africa H2R Africa Full time

Our client in the Medical Industry, based in 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 that healthcare services requiring pre-authorization are evaluated and processed efficiently, aligning with medical necessity and policy guidelines.

Responsibilities:

  • Attend to incoming calls from healthcare service providers and members/ beneficiaries.
  • Verification of the eligibility of cover within available benefits as per scheme rules, clinical protocols and funding guidelines.
  • Loading of authorisations and the application of standard predictable within a telephone call.
  • Strict adherence to benefits, scheme rules, clinical protocols and funding guidelines across all services and authorisation categories.
  • Clinical Risk Management to reduce the risks associated with hospitals and other authorised services.
  • Establish the presence of any co-morbid conditions from the caller or beneficiary if caller is not able to assist.
  • Refer to member management (case management) if co-morbid conditions are present for intervention and follow-up.
  • Attend to general enquiries.
  • Prepare and present cases for escalation to member management for discussion and resolution.
  • Provide member care and education to patients with and without chronic conditions who need to participate in any of the registered active disease management programs.

Minimum Requirements:

  • Registered/ Enrolled Nurse
  • Valid registration with SANC
  • Minimum 2-3 years experience in a similar role within a managed healthcare or medical scheme environment
  • Sound knowledge of the South African Healthcare industry and prevailing legislation, current coding structures i.e. ICD10s, CPT4, NRPL, PMB conditions and clinical protocols
  • Thorough, well-grounded clinical knowledge of the pre-authorisation of hospital admissions (including Length of Stay and Level of Care), in-rooms procedures and other healthcare services requiring pre-authorisation
  • Excellent telephonic and written communication capability within a call centre environment (will be tested)
  • Computer literate (will be tested) - MIP Application System experience will be advantageous
  • Customer service orientation
  • Ability to liaise with external parties clinicians and members and to make decisions
  • Demonstrated ability to effectively deal with emotionally charged and stressful situations
  • Self-motivator and the ability to work effectively in an independent environment
  • Good organisational and task prioritisation skills
  • Outstanding multitasking skills
  • Proficiency in English written and verbal (an additional language will be advantageous)
  • Ability to research and analyse information
  • High degree of accuracy and attention to detail
  • Compile and submit relevant reports in accordance with strict deadlines
  • Results orientated
  • Maintaining confidentiality of information