To ensure best practice is followed in providing medical care and treatment.
Requirements
- Matric.
- Enrolled or Registered Nurse.
- 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.
- Attain daily KPI of 70 ;meet the prescribed number of calls (240seconds Handling time per call).
- Maintain quality customerservice.
- Bin management turn- aroundtime of 48 hours.
- Implementation ofpolicies/protocols related toscheme benefits.
- Benefits in and out of hospital isappropriately controlled.
- Exclusions are correctly andconsistently applied.
- Positive relationships are builtand maintained with hospitalsand providers.
- Appropriate referral to casemanagement team.
