Member Clinical Associate

2 weeks 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 within available benefits as per scheme rules, clinical protocols and funding guidelines.
- Loading authorisations
- 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 hospital 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.
- Prepare and present cases for escalation to member management for discussion and resolution.
- Provide member care and education to patients

**Skills and Competencies Required**:

- 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. ICD10’s, 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
- 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

**Qualifications**:

- Registered/ Enrolled Nurse
- Valid registration with SANC

**Hours**:
Shift work between 7h00 and 19h00 (Monday to Sunday).

**Required**:
ASAP



  • Pretoria, South Africa Careforce Recruitment Full time

    **Position**:Member Care Clinical Consultant (Pre-authorisations) **Reporting to**: Operations Manager: Contact Centre **Location**:Head Office - Lynnwood, Pretoria (On-site) **Salary**: Market related CTC package that includes medical scheme and provident fund - **You will be required to work shifts between 07h00 and 19h00 (Monday to...


  • Pretoria, South Africa Careforce Recruitment Full time

    Position**:Member Care Clinical Consultant (Pre-authorisations)** Reporting to**:Operations Manager: Contact Centre Location: Head Office - Lynnwood, Pretoria **Salary**: Market related CTC package that includes medical scheme and provident fund **Qualifications**: - Registered/ Enrolled Nurse - Valid registration with SANC - _You will be required to work...


  • Pretoria, South Africa iMedrecruit Full time

    A specialist Physician based in a private practice in Pretoria, is looking for a clinical nursing assistant or a clinical associate/technician who can perform general administrative duties, reception cover and basic clinical duties> **Requirements (but not limited to)**: - Diary and appointment management when required. - Assistance with ECG's, stress...


  • Pretoria, South Africa H2R Africa Full time

    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 e.g ICD10s, CPT4, NRPL, PMB conditions and clinical protocols. - Thorough, well-grounded clinical knowledge of the pre-authorisation of...


  • Pretoria, South Africa iMedrecruit Full time

    About the job Clinical Nursing Assistant / Clinical Technician A specialist Physician based in a private practice in Pretoria, is looking for a clinical nursing assistant or a clinical associate/technician who can perform general administrative duties, reception cover and basic clinical duties> **Requirements (but not limited to)**: - Diary and...


  • Pretoria, South Africa HAKI Employers Association of South Africa Full time

    **Member Relations Advisors** **Haki Employers Association of South Africa**’s vision is to deliver effective and efficient representation and service which serves social justice, labour peace and economic growth to our members who are employers in South Africa. We are based in Pretoria. Our goal is to grow membership in our targeted employers, primarily...


  • Pretoria, South Africa DPT Recruitment Full time

    **Job Purpose** To lead the development and implementation of the Member Protection objectives and functions of the organisation to ensure that members and beneficiaries of medical schemes are protected, serviced, and enabled. You will work within the organisation and report to the Chief Executive & Registrar. **Key Performance Areas** - To lead and...


  • Pretoria, South Africa H2R Africa Full time

    **PLEASE ONLY APPLY IF YOU QUALIFY IN FULL. IF YOU DO NOT GET FEEDBACK WITHIN TWO WEEKS PLEASE CONSIDER YOUR APPLICATION TO BE UNSUCCESSFUL**. Bachelor's degree in Business Administration and/ or Degree/Diploma in Nursing with management experience Minimum 5-years experience within a healthcare provider liaison/ key account role within a managed...


  • Pretoria, South Africa RecruitForce Full time

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


  • Pretoria, South Africa Recruitforce Group Full time

    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 Competencies Required**: -...


  • Pretoria, South Africa University of Pretoria Full time

    **UP Posting - Academic**: FACULTY OF VETERINARY SCIENCE DEPARTMENT OF PRODUCTION ANIMAL STUDIES LECTURER/SENIOR LECTURER/ASSOCIATE PROFESSOR: SMALL STOCK FLOCK HEALTH (ONE POST)- The University of Pretoria's commitment to quality makes us one of the top research Universities in the country and gives us a competitive advantage in international science and...

  • Medical Advisor

    4 days ago


    Pretoria, South Africa Qetello Holdings Full time

    **Duties**: - Responsible for benefit-risk management through the following actions: - Evaluate and authorise procedures and out-of-hospital benefits; - Assist Case Management with the clinical justification of hospital benefits, including appropriate levels of care and/or alternatives to hospital admission; - Give input regarding the management of...

  • Medical Scheme Case Manager

    Found in: Talent ZA C2 - 2 weeks ago


    Pretoria, South Africa MNA Recruitment Full time

    A leading medical aid scheme company is seeking a Case Manager. The purpose of this role is to actively manage the clinical appropriateness and risk (both financial and clinical) of all hospital events and associated healthcare services in accordance with the relevant scheme rules, clinical protocols, and funding guidelines. To participate in the clinical...


  • Pretoria, South Africa HotelJobs.co.za Full time

    We are seeking a Front Office Associate / Receptionist for our Hotel in Pretoria Main duties and responsibilities: - Adhere to check in and check out procedures - Regular updating of guest lists and forward to departments - Reporting of faults using the maintenance log - Close liaison with Housekeeping on check-outs - Be familiar with the Hotel's Rates...

  • Medical Advisor

    6 days ago


    Pretoria, South Africa Dymaxa Recruitment Full time

    Our client, a non-profit, medical scheme is seeking a **Medical Advisor: Advisory, Risk and Quality Management** in the **Faerie Glen** area. **Duties include the following, but not limited to**: - Provide clinical advice to Bestmed and its member regarding hospital benefit and risk management. - Support and advice for Disease Management and Managed Care...


  • Pretoria, South Africa Abt JTA Full time

    We are currently seeking expressions of interest for mid-career (5+ years of experience) and senior (10+ years of experience) professionals in the international development - health sector. We are particularly keen to hear from full-time consultants with an established track record in the delivery of high-quality short-term technical assistance. If you have...

  • Pharmaceutical Benefit Management

    Found in: Adzuna ZA B C2 - 10 hours ago


    Pretoria, South Africa Adzuna ZA B C2 Full time

    PLEASE DO NOT APPLY IF YOU DO NOT QUALIFY IN FULL.FULL JOB SPEC AVAILABLE ON REQUEST.Registered Qualified Pharmacist Assistant (Post Basic).(Basic pharmacist assistant will not be considered for the position)Valid registration with SAPC.To perform drug utilisation review and actively manage and coordinate the approval of a members chronic medicine and to...

  • Pharmaceutical Benefit Management

    Found in: Whatjobs ZA C2 - 13 hours ago


    Pretoria, South Africa H2R Africa Full time

    PLEASE DO NOT APPLY IF YOU DO NOT QUALIFY IN FULL.FULL JOB SPEC AVAILABLE ON REQUEST. Registered Qualified Pharmacist Assistant (Post Basic).(Basic pharmacist assistant will not be considered for the position)Valid registration with SAPC.To perform drug utilisation review and actively manage and coordinate the approval of a members chronic medicine and to...

  • Pharmaceutical Benefit Management

    Found in: Talent ZA 2A C2 - 22 hours ago


    Pretoria, South Africa H2R Africa Full time

    PLEASE DO NOT APPLY IF YOU DO NOT QUALIFY IN FULL.FULL JOB SPEC AVAILABLE ON REQUEST.Registered Qualified Pharmacist Assistant (Post Basic).(Basic pharmacist assistant will not be considered for the position)Valid registration with SAPC.To perform drug utilisation review and actively manage and coordinate the approval of a members chronic medicine and to...

  • Health Programme Coordinator-Middelburg, Mpumalanga

    Found in: Talent ZA C2 - 2 weeks ago


    Pretoria, South Africa MNA Recruitment Full time

    A leading medical aid scheme company is seeking a Health-Programme-Coordinator.RequirementsKey Responsibilities: Confidential management of patient medical conditions, treatment, and funding information.  Driving risk-based preventative intervention and care through the Schemes model and programmes, including health risk assessments (HRA’s), hospital and...