Job Description

Are you a Nurse with a valid SANC registration?
Our client in healthcare insurance is looking for a dedicated and skilled healthcare professional for immediate employment.This is a 3-month temp position.We are looking for someone with:
xe2x9cx94xefxb8x8f 2-3 years of proven experience in a similar healthcare managed care role.
xe2x9cx94xefxb8x8f Strong clinical and risk management knowledge, with the ability to apply this effectively.
xe2x9cx94xefxb8x8f A solid understanding of the South African Health Industry, including benefits, regulations, and the current healthcare environment.
xe2x9cx94xefxb8x8f Familiarity with ICD codes, modifiers, and RPL tariff structures.
xe2x9cx94xefxb8x8f Excellent communication and interpersonal skills, with a strong customer-focused approach.
xe2x9cx94xefxb8x8f The ability to liaise effectively with clinicians and members in a professional and empathetic manner.Responsibilities will include:

• Providing cost-effective Managed Healthcare services while ensuring quality patient care.

Delivering high-quality call centre assistance to enhance member satisfaction and resolve queries efficiently.

• Conducting clinical assessments and triaging members to ensure they are directed to the most appropriate level of care.
• Pre-authorising physical General Practitioner (GP) consultations based on thorough clinical evaluations.
• Referring members to relevant healthcare providers within our network, including Intercare, Pharmacy Nurse Clinics, and Reality Wellness.
• Promoting and implementing sound clinical risk management strategies to optimise patient outcomes and minimise potential risks.
• Conducting audits on GP claims to ensure accuracy and adherence to ICD-10 coding standards.
• Maintaining strict compliance with Service Level Agreements (SLAs) and consistently upholding efficient customer service standards.

Do you have what it takes?

• Matric Certificate
• Registered as an Enrolled Nurse or Enrolled Nursing Auxiliary with the South African Nursing Council (SANC)
• Valid and active membership with SANC
• Bilingual, with strong communication skills in both Afrikaans and English.

Skills SANC

Watershed Consulting