Jobs in Go!

Our client in the insurance space is looking for an Enrolled Nurse with excellent clinical and risk management knowledge. • 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 • 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 • Matric • Enrolled Nurse / Enrolled Nursing Auxiliary • Valid membership of SANC • At least 2-3 years' experience in a similar role • Excellent clinical and risk management knowledge • ICD codes, modifiers and RPL tariff knowledge and understanding • Ability to liaise with clinicians and members • Excellent oral and written communication skills Market related Apply Now

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Jobs in Go!