Consultant: Medical Management
5 days ago
We are recruiting for a consultant: Medical Management position.
**Purpose of the job**:The Consultant: Medical Management is responsible to implement the medical management activities, medical exception handling and providing administration support in claims processing.
**Key Performance Areas**
**Medical management**
- Conduct medical assessment and compile injury assessment reports.
- Conduct assessments and bill reviews on submitted claims, focusing on the appropriate level of care, the length of stay, and quality of care.
- Incorporate tariffs, cost savings initiative recording, and treatment protocol to ensure that all service providers adhere to the rules, and the tariff as guided by the company and / or any that is considered reasonable.
- Pre-authorise submitted claims aligned to company clinical guidelines including the company formulary, treatment protocols and related tariffs.
- Escalation of complex cases for multi-disciplinary review and adjudication.
- Participate in the consultations process on the implementation of medical claims processes.
**Exception handling.**
- Ensure the implementation and maintenance of a formal exception handling process within the medical management.
- Maintain the documentation and regular updating of the exception handling process.
- Maintain the implementation an unusual occurrence procedure.
- Reporting
- Track and report against set objectives and targets.
- Report on emerging risks.
- Provide ad hoc reports on process improvement initiatives.
- Produce documents, briefing papers, reports, and presentations.
**Stakeholder management**
- Deal with/and respond to correspondence.
- Maintain healthy relationships with all stakeholders.
- Follow up and resolve all queries, up and make recommendations on which corrective actions are appropriate.
- Follow up and feedback to all stakeholders to keep them updated on the status of a query.
- Respond to queries within the predefined turnaround times.
**Qualifications**
- Bachelor’s Degree/Advanced Diploma in Health Sciences/ Medical related qualification.
- Registration with HPCSA/SANCA
**Experience**
- Relevant 3 years’ experience in a Medical related environment
- Technical and behavioural competencies required
- Claims management process/ processes and systems.
- Medical product management
- Medical bill reviewing
- Medical case management
- Complex problem identification, solving and decision making
- Customer value proposition
- Strong clinical analytical capabilities
- Knowledge of motor vehicle accident legislation Planning, Organising and Coordinating.
- Personal Mastery.
- Judgement and Decision Making.
- Ethics and Values.
- Client Service Orientation.
For more information please contact:
**Tebogo Rankhumise
-
Medical Management Consultant
1 month ago
East London, Eastern Cape, South Africa Road Accident Fund Full timeJob Title: Consultant: Medical ManagementThis is a 12-month, fixed-term contract position at the Road Accident Fund. As a Consultant: Medical Management, you will be responsible for implementing medical management activities, medical exception handling, and providing administration support in claims processing.Key Responsibilities:Conduct medical assessments...
-
Consultant: Medical Management
1 week ago
East London, South Africa Road Accident Fund Full timeJob title : Consultant: Medical Management Job Location : Eastern Cape, East London Deadline : December 13, 2024 Quick Recommended Links Jobs by Location Job by industries Key Performance Areas Medical management Conduct medical assessment and compile injury assessment reports. Conduct assessments and bill reviews on submitted claims,...
-
Consultant: Medical Management
4 days ago
East london, South Africa Nambiti Technologies Full timePurpose of the job: The Consultant: Medical Management is responsible to implement the medical management activities, medical exception handling and providing administration support in claims processing. Key Performance Areas Medical management Conduct medical assessment and compile injury assessment reports. Conduct assessments and bill reviews on...
-
Consultant: Medical Management
5 days ago
East London, South Africa Nambiti Technologies Full timePurpose of the job: The Consultant: Medical Management is responsible to implement the medical management activities, medical exception handling and providing administration support in claims processing. Key Performance Areas Medical management Conduct medical assessment and compile injury assessment reports. Conduct assessments and bill reviews on submitted...
-
Consultant: Medical Management
1 month ago
East London, South Africa Road Accident Fund Full timeNote: This is a 12-month, fixed-term contract position Purpose of the job: The Consultant: Medical Management is responsible to implemement the medical management activities, medical exception handling and providing administration support in claims processing. Key Performance Areas Medical management Conduct medical assessment and compile injury assessment...
-
East London, South Africa Jobted ZA C2 Full timePurpose of the job: The Consultant: Medical Management is responsible to implement the medical management activities, medical exception handling and providing administration support in claims processing. Key Performance Areas Medical management - Conduct medical assessment and compile injury assessment reports. - Conduct assessments and bill reviews on...
-
Consultant Medical Management
4 days ago
East London, South Africa Jobted ZA C2 Full timeQualifications and Experience: - Bachelors Degree/Advanced Diploma in Health Sciences /Medical related qualification. - Registration with HPCSA/SANCA - Relevant 3 years experience in a Medical related environment - Conduct medical assessment and compile injury assessment reports. - Conduct assessments and bill reviews on submitted claims, focusing on the...
-
Consultant Medical Management
6 days ago
East London, South Africa Six Sense Consulting Full timeQualifications and Experience:Bachelors Degree/Advanced Diploma in Health Sciences /Medical related qualification.Registration with HPCSA/SANCARelevant 3 years experience in a Medical related environmentConduct medical assessment and compile injury assessment reports.Conduct assessments and bill reviews on submitted claims, focusing on the appropriate level...
-
Senior Medical Management Specialist
5 days ago
East London, Eastern Cape, South Africa Nambiti Technologies Full timeNambiti Technologies is seeking an experienced Senior Medical Management Specialist to join our team.The ideal candidate will have a strong background in medical management, with at least 3 years of experience in a related environment. They will be responsible for implementing medical management activities, handling exceptions, and providing administration...
-
Medical Receptionist
6 months ago
East London, South Africa Abantu Staffing Solutions Full timeA general medical practice is seeking a Medical Receptionist with a passion for family orientated health care. This practice has been running since 1951 with a legacy of holistic patient centred care. There are 2 practices, in Southernwood and Beacon Bay. We have 9 general practitioners who rotate through both practices. Our GPs offer a comprehensive range...
-
Medical Management Professional
1 week ago
East London, Eastern Cape, South Africa Road Accident Fund Full timeJob OverviewWe are seeking a highly skilled Medical Management Professional to join our team in Eastern Cape. The successful candidate will be responsible for conducting medical assessments, reviewing claims, and implementing medical management processes.
-
Medical Officer
6 months ago
East London, South Africa Tych Business Solutions Full time**Job ID**: 66188**Date Posted**: Posted 12 mins ago**Location**: East London**Job Title**: MEDICAL OFFICER - EAST LONDON - EASTERN CAPE The main purpose of the position is to implement clinical trials and render efficient and effective clinical care to volunteers/participants on research studies and clients at our client’s research site in East London....
-
Medical Services Operations Manager
4 weeks ago
East London, Eastern Cape, South Africa Abantu Staffing Solutions Full timeJob Title: Medical Services Operations ManagerAbout the Role:We are seeking an experienced and skilled Medical Services Operations Manager to join our team at Abantu Staffing Solutions in East London. The successful candidate will be responsible for managing the overall operations of our Support Department, encompassing patient bookings, reception,...
-
Medical Debtors Clerk
6 days ago
East London, South Africa Jobted ZA C2 Full timeOverview: Our client in the health sector is looking to employ a Medical Debtors Clerk. The successful candidate will become part of a professional team that continuously strives for the highest standards of quality. The successful candidate will be responsible for accurately feeing all job cards so that timeous payment may be received on all accounts. This...
-
Head of Medical Affairs
6 months ago
East London, South Africa Aspen Pharma Group Full timeRole Purpose To manage the medical affairs department, in alignment with the organizational strategy and objectives as per Aspen code of compliance and industry standards. To manage and oversee medical information, Promotional non promotional compliance and medical scientific support for the Aspen EME existing portfolio and input required for building a...
-
Medical Debtors Clerk
6 days ago
East London, South Africa Abantu Staffing Solutions Full timeOverview: Our client in the health sector is looking to employ a Medical Debtors Clerk. The successful candidate will become part of a professional team that continuously strives for the highest standards of quality. The successful candidate will be responsible for accurately feeing all job cards so that timeous payment may be received on all accounts. This...
-
Medical Officer
6 months ago
East London, South Africa Truniq Professional Services Full time**Medical Officer (Investigator of Record)** **East London - 3-year fixed term contract (non-profit organization)** **Must be able to start in September** MBChB and HPCSA registration as a medical practitioner (independent practice). 3 or more years’ work experience in the clinical research environment. Proven experience as a Principal...
-
Medical Support Services Leader
1 month ago
East London, Eastern Cape, South Africa Abantu Staffing Solutions Full timeMedical Services Support Manager Job DescriptionAbantu Staffing Solutions seeks a highly skilled Medical Services Support Manager to oversee the Support Department. This role entails managing patient bookings, reception, reporting, authorizations, porters, drivers, and Ultrasound Assistants at multiple branches.Key ResponsibilitiesManage the Support...
-
Project Manager
6 months ago
East London, South Africa Hanani Project Management Solutions (PTY) Ltd Full timeWe are currently looking for graduates that want to start a career in Project Management. The position offered is that of a Graduate Consultant Intern. The intern program is a 12 month structured program. This position provides broad exposure to the project management consulting industry with in-depth applied training and exposure. You will be placed, as...
-
East London, Eastern Cape, South Africa Abantu Staffing Solutions Full timeOverview:We are seeking a highly skilled Medical Debtors Clerk to join our team at Abantu Staffing Solutions.The successful candidate will be responsible for accurately processing job cards, ensuring timely payments, and providing exceptional customer service. This role also involves serving as Switchboard relief.Salary: R120,000 - R180,000 per annum,...