Job Description
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 de...