Registered Nurse - Johannesburg, South Africa - National Risk Managers

National Risk Managers Johannesburg, South Africa

Found in: Talent ZA C2 - 17 hours ago

Description

A Medical Insurance Company based in Benoni is looking for a Registered Nurse who will consult with members via relevant platforms to diagnosis and provide treatment plans for members according to Primary Healthcare Guidelines. Ensuring best clinical practice and quality is always provided to members. Handling of calls within Service level agreements.

Key Performance Areas

Determine appropriate treatment once diagnosed.
Perform administrative duties.

Key Tasks

Determine appropriate treatment once diagnosed.

Establish member's 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
Continue with ongoing Learning and Development to stay abreast with healthcare industry
Capture of accurate clinical records on system
Provide effective communication to encourage and maintain behavioural
Script to schedule 4, when clinically appropriate
Issue Sick notes when clinically appropriate
Adhere to time and

Secondary Tasks / Activities

Prioritize incoming authorization requests and/or queries according to urgency.
Assess pre-authorisation requests for GP visits, specialist visits, emergency 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.

Other requirements

Registered with SANC
Call Centre experience
Dispensing Certificate

Essential Qualifications

Matric
Nursing Diploma/Degree

Desirable Qualifications

Dispensing Certificate

Essential Experience

Experience in clinical evaluation of patient's signs and symptoms
IT system navigation

Desirable Experience

Primary Healthcare
Call Centre experience
Dispensing Certificate
Experience in issuing of scripts as per regulation
Experience in issuing of sick notes as per regulation

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

Attributes

Holistic thinker
Critical thinker
Able to work under pressure
Team player
Compassionate
Honest, hardworking, and humble

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