Position: Clinical Care Coordinator: PMB Reviews and Special Cases

Location: Centurion, Gauteng

Position Purpose: To provide expert clinical assessment and decision making in relation to Prescribed Minimum Benefit reviews, ex gratia applications, regulatory complaints, escalations, and non-disclosure investigations.

Experience: 5 years relevant managed care, health risk and clinical customer service within Medical Scheme Administration Industry or similar.

Solid working experience with the following:

Prescribed Minimum Benefit (PMB) reviews, Ex Gratia reviews, Council for Medical Schemes (CMS) complaints, non-disclosure investigations, Scheme and social medica escalations of a clinical nature

Qualifications: Registered Nurse with medical diploma/degree and valid SANC registration ( MANDATORY REQUIREMENT )

Accountabilities:

Client service delivery and quality Follow procedures and cooperate with peers and leader for best possible ...