Clinical Consultant X2 Mmh240902-4

Role PurposeTo ensure best practice is followed in providing medical care and treatment.RequirementsMatric.Registered Nurse is essential.2-3 years' experience within the managed care industry.Excellent understanding of the scheme products and legislation.Effective management of scheme rules in line with clinical guidelines.Knowledge of PMB guidelines.Telephonic etiquette.Duties and ResponsibilitiesAttain daily KPI of 70 – meet the prescribed number of calls (240 seconds Handling time per call).Maintain quality customer service.Bin management turn-around time of 48 hours.Implementation of policies/protocols related to scheme benefits.Benefits in and out of hospital are appropriately controlled.Exclusions are correctly and consistently applied.Positive relationships are built and maintained with hospitals and providers.Appropriate referral to case management team.
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