SENIOR CLINICAL ESCALATIONS

Genesis Medical Scheme is seeking to appoint a Senior Clinical Consultant in the Clinical department, to provide guidance/coaching to the Clinical Consultants and to handle escalated queries regarding Hospital Admissions and Oncology Case Management.

The position is aimed at a dynamic and performance driven individual who is able to deliver administrative outputs whilst at the same time working effectively with people.

The candidate must be bilingual and have the ability to express themselves professionally in verbal and written communication.

Experience in the area of case management, pre-authorisation and/or oncology management within the medical schemes environment is required.

Key Responsibilities:

• Manage all clinical escalated queries
• Assisting/Coaching the consultants with clinical aspects
• Application of Scheme Rules in terms of relevant health services
• Professional communication skills, written and verbal
• Ad-hoc Clinical Investigations/Reports
• Drafting professional notifications to Case Managers, Service Providers and Members
• Identification of trends and irregularities in claims patterns

The following qualifications are required:

Registered Nurse with SANC
Minimum 5 years working experience within a healthcare facility
Minimum 2 years’ experience in the Medical Scheme environment
Working knowledge of Medical Schemes Act
Extensive knowledge of hospital billing rules, industry tariffs (including ICD10 Codes, UPFS, CPT4 Coding, SEP, NAP and PMB’s)

SKILLS:
Bilingual in English and Afrikaans
Excellent attention to detail
Good leadership skills
Excellent communication skills
MS Office proficiency