Clinical Consultant: Oncology

2 weeks ago

Centurion, 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 clinical-related 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 cost-effective 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 cost-effective 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

  • Consultant: Clinical Auditor

    4 weeks ago

    Centurion, South Africa PPS Recruitment Full time

    **Job Advert Summary**: Applications are invited for the above-mentioned position, to be filled as soon as possible. **Minimum Requirements**: - Nursing qualification. - Clinical Auditing experience - Minimum of 2 years' experience in the managed care environment **Duties and Responsibilities**: - Conduct clinical audits on claims and costs to ensure...

  • Consultant:pre- Authorisation

    3 weeks ago

    Centurion, South Africa PPS Recruitment Full time

    **Job Advert Summary**: An exciting opportunity for an analytical and attention-to-detail Pre Applications are invited for the above-mentioned position, to be filled as soon as possible. **Minimum Requirements**: - Nursing qualification. - Emergency Services qualification or any other Clinical/Medical qualification - Previous exposure in a Managed...

  • Global Project Leadership

    4 weeks ago

    Centurion, South Africa Novasyte Full time

    Our Project Leadership Interns are an integral part of our global team and work in partnership with Project Management Analysts and Project Leaders in one of our therapeutic areas including Internal Medicine, Central Nervous System, Gastroenterology, Immunology & Women’s Heath, Cardiovascular Renal Metabolic, Early Phase Oncology and Late Phase...

  • CRA II

    4 weeks ago

    Centurion, South Africa Fortrea Full time

    As a leading global contract research organization (CRO) with a passion for scientific rigor and decades of clinical development experience, Fortrea provides pharmaceutical, biotechnology, and medical device customers a wide range of clinical development, patient access and technology solutions across more than 20 therapeutic areas. With over 19,000 staff...

  • Senior Consultant: Management Consulting

    4 weeks ago

    Centurion, South Africa IQVIA Full time

    IQVIA South Africa has a great opportunity for a Senior MC Consultant position in our Commercial Solutions team based in Centurion. Responsible for the on-time completion of projects or components of large, complex projects for clients in the life sciences field. Identifies and elevates potential new business opportunities and assists in the sales...

  • Primary Market Research Consultant

    4 weeks ago

    Centurion, South Africa IQVIA Full time

    Purpose: Provides high quality, on-time input to client projects in the life sciences field. Assignments range in complexity from primary market research, basic analysis and problem solving. Will serve as project leader for small teams or work streams. Principal Accountabilities: Assists with the review and analysis of client requirements or problems...

  • Coach : Hospital Benefit Managemant

    1 week ago

    Centurion, South Africa PPS Recruitment Full time

    **Job Advert Summary**: A new opportunity is open to an adaptable and people orientated team player, to provide on the job training and support to new clinical staff and coachees towards the enhancement of their skills in order to accomplish tasks optimally. **Minimum Requirements**: - Grade 12 certificate - A Registered Nursing qualification - A minimum...

  • Consultant: Disease Risk Management

    7 days ago

    Centurion, South Africa PPS Recruitment Full time

    **Job Advert Summary**: The position reports to the Service Manager: Disease Risk Management. **Minimum Requirements**: - Grade 12 - A Registered Nursing qualification - Disease Risk Management is essential - Sound knowledge of the Coding Systems: ICD10 & CPT4 Principles and sound knowledge of the Medical Aid Industry, Rules & Regulations, ISO and other...

  • Recruitment Consultant

    2 days ago

    Centurion, South Africa IQVIA Full time

    Support the continuous improvement of the staffing function through development and implementation for all staffing programs in an assigned business unit/department, primarily in one geography. May be required to assist with providing staffing support to assigned management team for a geographically distributed organization or pan regional, as assigned....

  • Coach : Integrated Care Management

    4 weeks ago

    Centurion, South Africa PPS Recruitment Full time

    **Job Advert Summary**: **Minimum Requirements**: - Have a grade 12 qualification - A Tertiary qualification will be an added advantage - Be able to develop a training needs analysis in line with our Performance Management System and ensure training interventions accordingly - Be able to transfer skills and knowledge - Develop and maintain Work Procedures...

  • Executive: Member Protection

    4 weeks ago

    Centurion, South Africa Letshalo HR Services Full time

    **Key Responsibilities **include but not limited to the following: - To lead and coordinate the development of the strategic plan, annual performance plan, and operational plans of the different Member Protection sub-divisions to ensure statutory reporting within set deadlines; - To ensure alignment of strategy and budget allocations on an ongoing basis; -...

  • Business Development Manager

    4 weeks ago

    Centurion, South Africa IQVIA Full time

    Job Summary Secure and retain business through professional, consultative, proactive sales activities directed at decision-makers and decision influencers at existing and prospect clients. Grow pipeline and subsequently revenue by leveraging the full IQVIA portfolio and identifying new business opportunities. Coordinate with the sales, business and...

  • Territory Account Manager KZN

    4 weeks ago

    Centurion, South Africa Elanco Full time

    At Elanco (NYSE: ELAN) – it all starts with animals!As a global leader in animal health, we are dedicated to innovation and delivering products and services to prevent and treat disease in farm animals and pets. We’re driven by our vision of ‘Food and Companionship Enriching Life’ and our approach to sustainability – the Elanco Healthy Purpose –...