Registered Nurse - benoni
National Risk Managers ( Affinity Health)
East Rand, Gauteng, ZA
4d ago
source : Careers24
  • To provide clinical support
  • To be able to offer accessible, quality and affordable healthcare solutions
  • To involve the use of ICT (information and communication technology)
  • To improve members health outcomes *Tasks / Activities* *Determine appropriate treatment once diagnosed*
  • Establish members primary diagnosis based on signs and symptoms
  • Identify the most appropriate treatment plan according to Clinical Guidelines for the member
  • Communicate correct benefits and Product knowledge
  • Evaluation of first time resolution of members calls
  • Action cases sent to Medical Consultant within the SLA
  • Encourage appropriate OTC utilization
  • Encourage appropriate Acute Medication Benefit utilization
  • Deliver appropriate information to healthcare users
  • Educate members of potential side effects to medication
  • Provide members with information and advice on prescribed over the counter medication. *Perform administrative duties*
  • Improve areas identified by the QA team
  • Continue with ongoing Learning and Development to stay abreast withhealthcare industrychanges
  • Capture of accurate clinical records on system
  • Provide effective communication to encourage and maintain behavioural change
  • Script to schedule 4, if and when clinically appropriate
  • Issue Sick notes if and when clinically appropriate
  • Adhere to time and attendance *Secondary Tasks / Activities*
  • Prioritize incoming authorization requests and / or queries according to urgency
  • Assess pre-authorisation requests for GP visits, specialist visits, emmergency room visits, diagnostic procedures, hospitalisation for illness and accident events, including the appropriate facilities (day clinics, sub-acute facilities, home nursing and preferred providers)
  • To check the reasons for authorisation and documentation received are appropriate and confirm if it according to set protocols, guidelines, formularies and preferred provider agreements.
  • Based on protocols approved or decline. If the reason for authorisation is not defined in the protocols or guidelines escalate the case for clinical review

  • Approve or decline benefits accurately according to the benefits per benefit option and strictly according to the protocols * Essential Experience*
  • Experience in clinical evaluation of patients signs and symptoms
  • IT system navigation *Essential Qualifications*
  • Nursing Diploma / Degree
  • Primary Healthcare (trained / experience)
  • Registered with SANC
  • Call Centre experience (advantage)
  • Dispensing Certificate (advantage)
  • Prepared to work shifts
  • Reside in East rand or willing to travel to the East rand *Knowledge and Skills*
  • Extensive MS Office knowledge
  • Strong written and verbal communication skills
  • Good telephonic etiquette
  • Good listening skills
  • Strong administration skills
  • Knowledge in Primary Healthcare
  • Strong organisation skills
  • Good time management skills
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