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Registered Nurse - benoni

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Reference: 

RN - Benoni

Location: 

East Rand

Source: 

National Risk Managers ( Affinity Health)

Remuneration: 

R25 000.00 - R35 000.00 Per Month

 

  • 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

Industry: 

Call Centre

Job Type: 

Permanent

Date Posted: 

2021-04-07

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