Enrolled Nurse

About the position

3 Months Temp

Nurse Consultant role in the Healthcare Insurance space.
Enrolled Nurse / Enrolled Nursing Auxiliary with a valid membership of SANC

Duties

• Delivering a cost-effective Managed Healthcare service
• Effective Customer Service delivery
• Deliver an effective call centre service in order to achieve member satisfaction
• Responsible for incoming calls from Network GP rooms and members
• Clinically assess members and triage accordingly
• Where triage allows it, pre-authorise for physical GP consultation
• If triage does not allow a physical GP consultation, refer the member to the correct sub-category, for example, Intercare, Pharmacy Nurse Clinic, and Reality Wellness
• Manage clinical risk by promoting sound principles and strategies to decrease GP claims over utilisation
• Perform clinical audits on authorised GP claims and ensure the ICD-10 code(s) match the symptoms provided
• Classify and prioritise risks based on the frequency of member visits to a provider
• Ensure efficient Customer Service and compliance with agreed SLAs
• Manage and maintain data integrity and update accordingly where necessary
• Ensure all enquiries are resolved according to the business standard business rules while costing factors are maintained
• Ensure that all calls and cases are fully and clearly recorded on the system accordingly
• Escalate any concerns or matters that will result in unsatisfied customer service

Desired Skills:

• ICD 10
• Communication

Desired Qualification Level & Accreditations:

• Diploma
• South African Nursing Council

About The Employer:

Healthcare insurance company