Clinical Co-ordinator

2 weeks ago

Sandton, South Africa MSO International (Pty) Ltd Full time

**General description of the Job**:
Language**:Portugues (Advantageous)**

The Clinical Coordinator will work closely with the Clinical and Admin members of the International team to ensure alignment of activities as well as the achievement of client Service level objectives. He/ she is also responsible for the management of all pre-authorisation and medical assistance requests for local clients, and international health insurance members. He/ she will liaise with the Client’s client services contact centre, service providers and other members of the multi-disciplinary team to ensure the best outcome for all members.

**Education, Experience and Other requirements**:

- Grade 12
- A Degree or Diploma in Nursing, or other similar medical qualification
- 2 Years call centre experience an advantage
- A post basic specialisation in critical care / Emergency & Trauma / Operating Theatre nursing

would be an advantage
- Registration with SANC as Professional Nurse / Enrolled Nurse or other medical registration
- 2 years’ Experience in the Managed Healthcare funding / Administration Industry
- Experience with healthcare insurance risk management principles an advantage

**Knowledge, skills and attitude**:

- Sound knowledge Customer Service
- Good knowledge of Industry legislation and funding guidelines
- Knowledge of Medical Fund/ Health Insurance and healthcare risk management
- Clinical Knowledge a must
- Good communication skills, verbal and written
- Initiate and implement processes
- Participate in protocol and process development
- Computer Literacy
- Critical evaluation of information
- Sound clinical decision making ability
- Liaison, coordination and consulting skills
- Helpful, friendly and accommodating with a customer focused attitude
- Problem Solving
- Self-Motivated
- Patience and resilience
- Assertiveness
- Integrity
- Flexible and adaptable
- Output driven

**Duties and Responsibilities included but not limited for all MSO Companies and subsidiaries**:

- Align clinical activities to the Strategic objectives of the Business Unit.
- Work closely with team members and all stakeholders to ensure alignment of activities with client SLA objectives. Manage the entire spectrum of activities from pre-authorization, case coordination, clinical review through to discharge planning, chronic disease management and/or repatriation.
- To work shifts and hours as specified by operational requirements. Flexibility is essential.
- Ensure that call center service levels are met:

- All ACD calls to be answered in less than 3 rings (under 20 seconds)
- Manage call talk time/ duration to an average of 180 seconds ( 3 minutes)
- verify membership validity
- verify benefit available for treatment requested as per scheme/ Insurers benefit rules
- Assess medical necessity of treatment, appropriateness of facility, service provider and level of care - refer to medical protocols, consult with Clinical Manager / Medical Advisor as required or if uncertain.
- Approve /decline request and communicate appropriately with member/ service providers
- Update cases - based on utilisation review and clinical updates from hospital
- Attend to daily tasks as delegated, i.e. mail-box, daily pended status reports
- Liaise with scheme contact persons on funding decisions as required.
- Provide detailed feedback within the prescribed SLA time frame to clients.
- Co-ordinate on-site/telecom Case management visits as may be required from time-time to monitor, level of care, utilisation review, discharge planning / negotiation with hospital admin/ Treating Specialists.
- Participates in delegated projects
- Provide detailed feedback within the prescribed SLA time frame to management
- Liaise with clients and service providers as required.

**Education**:

- Diploma (preferred)

**Experience**:

- Managed Healthcare funding / Administration Industry: 2 years (required)
- call centre: 2 years (required)

**Language**:

- Portuguese (required)

License/Certification:

- SANC, Registered nurse/ Enrolled nurse (required)

Application Deadline: 2024/04/02

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