Medical Management Consultant

2 weeks ago

Johannesburg, Gauteng, South Africa Road Accident Fund Full time
Job Title: Consultant: Medical Management

Job Summary:

The Consultant: Medical Management is responsible for implementing medical management activities, medical exception handling, and providing administration support in claims processing. This role requires a strong clinical background and excellent analytical skills to ensure that all service providers adhere to the rules and tariffs as guided by the RAF and/or any that is considered reasonable.

Key Responsibilities:Medical Management
  • Conduct medical assessments 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 compliance with RAF clinical guidelines.
  • Pre-authorize submitted claims aligned to RAF clinical guidelines, including the RAF formulary, treatment protocols, and related tariffs.
  • Escalate complex cases for multi-disciplinary review and adjudication.
  • Participate in the implementation of medical claims processes.
Exception Handling
  • Ensure the implementation and maintenance of a formal exception handling process within medical management.
  • Maintain documentation and regular updates of the exception handling process.
  • Maintain the implementation of unusual occurrence procedures.
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, making recommendations on corrective actions.
  • Follow up and feedback to stakeholders on query status.
  • Respond to queries within predefined turnaround times.
Requirements:
  • Bachelor's Degree/Advanced Diploma in Health Sciences/Medical related qualification.
  • Registration with HPCSA/SANCA.
  • Relevant 3 years' experience in a Medical related environment.
Technical and Behavioral Competencies:
  • 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, Organizing, and Coordinating.
  • Personal Mastery.
  • Judgement and Decision Making.
  • Ethics and Values.
  • Client Service Orientation.

RAF offers Total Employment Cost packages with no additional contributions from the Employer. Successful candidates are required to structure their packages in a manner that will suit their needs.

  • Medical Management Consultant

    1 week ago

    Johannesburg, Gauteng, South Africa Road Accident Fund Full time

    Job Title: Consultant: Medical ManagementThe Road Accident Fund is seeking a highly skilled and experienced Consultant: Medical Management to join our team. As a key member of our medical management team, you will be responsible for implementing medical management activities, exception handling, and providing administration support in claims processing.Key...

  • Sales Consultant

    1 month ago

    Johannesburg, Gauteng, South Africa Energy at Work Projects Full time

    Unlock Your Sales Potential with Energy at Work ProjectsAre you a driven and customer-focused individual seeking a challenging role in sales? We're looking for a skilled Virtual Sales Consultant to join our team and leverage their expertise in medical insurance sales to thrive in a dynamic environment.About Our Company:Energy at Work Projects is a leading...

  • Management Consultant

    3 weeks ago

    Johannesburg, Gauteng, South Africa Management Solutions, S.L Full time

    Position OverviewAs a Business Consultant at Management Solutions, you will engage in diverse consultancy initiatives focusing on areas such as risk management, financial analysis, organizational transformation, and strategic marketing.Key ResponsibilitiesJoin and collaborate with teams on various consultancy projects, including:Risk management and...

  • Service Consultant

    1 month ago

    Johannesburg, Gauteng, South Africa Palesa Mbali Group Full time

    Job SummaryWe are seeking a highly skilled Service Consultant to join our team at Palesa Mbali Group. As a Service Consultant, you will be responsible for providing exceptional customer service to stakeholders in the medical scheme space.Key ResponsibilitiesCustomer Service Management: Manage customer service requests and strive to resolve queries on the...

  • Medical Office Manager

    1 week ago

    Johannesburg, Gauteng, South Africa Dynamic Outsourced Solutions Full time

    Medical Receptionist/Team LeaderWe are seeking a highly skilled and experienced Medical Receptionist/Team Leader to join our team at Dynamic Outsourced Solutions.Key Responsibilities:Leadership and Team Management: Manage and lead a team of receptionists in a busy medical practice environment, providing guidance and coaching to ensure excellent patient care...

  • Business Consultant

    2 months ago

    Johannesburg, Gauteng, South Africa Management Solutions, S.L Full time

    About the RoleWe are seeking a highly motivated and talented Business Consultant to join our team in Johannesburg. As a Business Consultant, you will play a key role in helping our clients achieve their business objectives by providing expert advice and guidance on business strategy, risk management, and financial planning.Key ResponsibilitiesConduct...

  • Business Consultant Johannesburg

    1 month ago

    Johannesburg, Gauteng, South Africa Management Solutions, S.L Full time

    Unlock Your Potential as a Business Consultant in JohannesburgManagement Solutions, S.L is seeking highly motivated and talented individuals to join our team as Business Consultants in Johannesburg. As a Business Consultant, you will play a key role in delivering business, risk, financial, organisational and process-related advisory services to our...

  • Business Consultant

    1 week ago

    Johannesburg, Gauteng, South Africa Management Solutions, S.L Full time

    Join Management Solutions as a Business Consultant in JohannesburgWe are seeking a talented Business Consultant to join our team in Johannesburg. As a Business Consultant, you will work with top industry management to address challenges at the national and global level.Key Responsibilities:Conduct risk management and control assessmentsDevelop and implement...

  • Business Consultant Johannesburg

    4 weeks ago

    Johannesburg, Gauteng, South Africa Management Solutions, S.L Full time

    Unlock Your Potential as a Business Consultant in JohannesburgManagement Solutions, S.L is seeking highly motivated and talented individuals to join our team as Business Consultants in Johannesburg. As a Business Consultant, you will play a key role in helping our clients achieve their business objectives by providing expert advice on risk management and...

  • Digital Transformation Consultant

    1 week ago

    Johannesburg, Gauteng, South Africa Management Solutions, S.L Full time

    Join Our Team as a Digital Transformation ConsultantWe are seeking a highly skilled Digital Transformation Consultant to join our team at Management Solutions. As a Digital Transformation Consultant, you will be responsible for helping our clients navigate the complex world of digital transformation and implement cutting-edge technological solutions to drive...

  • Medical Billing Manager

    2 weeks ago

    Johannesburg, Gauteng, South Africa St. John's Riverside Hospital Full time

    Job Title: Medical Billing ManagerSt. John's Riverside Hospital is seeking a highly skilled Medical Billing Manager to join our team. As a Medical Billing Manager, you will be responsible for supervising and coordinating the activities of medical billers and collectors to obtain and record financial data for statistical records.Responsibilities:Supervise and...

  • Digital Transformation Consultant

    3 weeks ago

    Johannesburg, Gauteng, South Africa Management Solutions, S.L Full time

    Join Our Team as a Digital Transformation ConsultantWe are seeking a highly skilled Digital Transformation Consultant to join our team at Management Solutions, S.L. in Johannesburg. As a Digital Transformation Consultant, you will play a key role in helping our clients navigate the complexities of digital transformation and implement innovative solutions to...

  • Consultant in Business Strategy

    3 weeks ago

    Johannesburg, Gauteng, South Africa Management Solutions, S.L Full time

    Position OverviewAs a Business Consultant at Management Solutions, you will engage in diverse consultancy projects focusing on various aspects such as risk management, financial oversight, and organizational transformation. You will collaborate with multidisciplinary teams to drive innovation and enhance business performance.Key Responsibilities- Participate...

  • Business Advisory Consultant

    3 weeks ago

    Johannesburg, Gauteng, South Africa Management Solutions, S.L Full time

    Position OverviewAs a key member of our consulting team, you will engage in various consultancy initiatives focusing on risk management, financial analysis, and organizational transformation. Your role will involve collaborating with multidisciplinary teams to deliver innovative solutions for our clients.Key Responsibilities - Participate in diverse...

  • Data Science Consultant Johannesburg

    1 week ago

    Johannesburg, Gauteng, South Africa Management Solutions, S.L Full time

    Unlock Your Potential as a Data Science Consultant in JohannesburgJoin Management Solutions, S.L, a leading international consulting firm, and embark on a rewarding career as a Data Science Consultant in our vibrant Johannesburg office. As a key member of our team, you will have the opportunity to work on high-profile consulting projects, collaborating with...

  • Digital Transformation Consultant

    1 month ago

    Johannesburg, Gauteng, South Africa Management Solutions, S.L Full time

    Unlock Your Potential as a Digital Transformation ConsultantJoin Management Solutions, S.L. in Johannesburg, South Africa, as a Digital Transformation Consultant and embark on a career-defining journey. Our team is seeking a talented individual to drive digital transformation initiatives for our clients, leveraging expertise in new technologies and digital...

  • Medical Insurance Sales Consultant

    2 months ago

    Johannesburg, Gauteng, South Africa Telebest Full time

    Telebest is seeking a skilled professional for the role of Gap and Medical Insurance Salesperson.Key Qualifications:Completion of Matric or equivalent SAQA accreditation is essential.FAIS accreditation and relevant qualifications are preferred.Regulatory Exam 5 certification is a plus.A minimum of 1 year of experience in telephonic sales is...

  • Product Manager Vascular Division Medical Devices Gauteng

    4 weeks ago

    Johannesburg, Gauteng, South Africa Salesworx Full time

    Job DescriptionJob Title: Product Manager Vascular Division Medical Devices GautengJob Summary:We are seeking a highly skilled and experienced Product Manager to join our team at Salesworx. The successful candidate will be responsible for managing the product lifecycle of our medical devices in the Vascular Division, ensuring that our products meet the needs...

  • Medical Billing Manager

    4 weeks ago

    Johannesburg, Gauteng, South Africa St. John's Riverside Hospital Full time

    Job SummaryWe are seeking a highly skilled and experienced Medical Billing Manager to join our team at St. John's Riverside Hospital. As a key member of our revenue cycle team, you will be responsible for supervising and coordinating the activities of medical billers and collectors, ensuring accurate and timely billing and collection of patient...

  • Regional Medical Officer P4

    4 weeks ago

    Johannesburg, Gauteng, South Africa Programa Mundial de Alimentos Full time

    Job Title: Regional Medical Officer P4WFP is seeking a highly skilled and experienced Regional Medical Officer P4 to join our team in Johannesburg, South Africa.About the RoleThe Regional Medical Officer P4 will be responsible for designing and coordinating the delivery of medical services in the region, promoting the health and safety of WFP staff, and...