CHRONIC BENEFIT CONSULTANT
Advert Ref: RMQ732
Advert Title: Chronic Benefit Consultant
Area: La Lucia, Durban
Advert Type: Full-Time
Working Hours: 40 Hours
Time Conditions: Dayshift
Salary: R15,000 – R32,000
Closing Date: 22 October 2022
The successful candidate will be required to manage the registration request for Chronic conditions/ treatment, chronic related queries and to give support to the Health Risk Management team. This position will report to the Medicine Risk Manager and is based in Umhlanga.
Post Basic Pharmacist assistant qualification is essential
Previous Health Risk Management experience would be an advantage
Previous experience in a managed care environment dealing with Health Risk Management would be an advantage
Registration with the Pharmacy Council as Pharmacist Assistant would be an advantage
Good telephone etiquette
Duties & Responsibilities
All interactions, telephonic and written, with members, providers, brokers and internal stakeholders to be professional
Registration of medicine and/or diagnosis to be done timeously and independently in accordance to La Lucia Hospital Health policies and scheme formularies
Develop effective relationships and ensure that Service Level Agreements with External clients and internal departments are maintained thus ensuring excellent service to the scheme, members, providers as well as internally
24 hour turnaround –; Maintain a consistent and quality 24 hour turnaround time from receipt of documents/calls into the Medicine Risk Management department
Provide 1st time and timeous resolution on queries
Provide effective management of a patients disease and lifestyle to promote an integrated and holistic approach to managing the healthcare of a member
To provide support and assistance to the DUR Pharmacist, DRM, HRM and Clinical Governance departments in terms of medical management and clinical input.
Ensure effective claims management service delivery and support
Perform an efficient and accurate administrative function to the team.
Identify all compliance risks and bring to the attention of the team leader for review.
Monitor customer delivery constraints and escalate to management
Identify and investigate all possible non-disclosure of pre-existing conditions
Identify the appropriate entry criteria and ensure consistent and correct authorizations in line with clinical policies and the relevant scheme rules and formularies
Have the capacity to develop oneself and others via the various training options thus positively growing oneself and the team.
Excellent verbal and written Communications Skills
Good interpersonal skills
Attention to detail
Stress tolerant and working under pressure
Drive and support effective teamwork within the Department
Interested Applicants who meet the requirements may apply here on our website or use the email address of La Lucia Hospital HR Manager STELLA VAN ROOY [firstname.lastname@example.org]. Applicants will be conducted shortly, Should you not be contacted in 14 days of your application, Please consider your application unsuccessful and thank you for your interest in our healthcare group.