Registered Nurses
job description
Vacancy Details
Employer:
Important Company
We are currently looking for Registered Nurses to consult with Affinity Health members via relevant platforms to diagnosis and Important Company treatment plans for members according to Primary Healthcare Guidelines.
Tasks:
Determine appropriate treatment once diagnosed:
Establish member-s primary diagnosis based on signs and symptoms
Identify the most appropriate treatment plan according to Clinical Guidelines for the member
Communicate correct benefits and Product knowledge
Evaluation of first time resolution of members calls
Action cases sent to Medical Consultant within the SLA
Encourage appropriate OTC utilization
Encourage appropriate Acute Medication Benefit utilization
Deliver appropriate information to healthcare users
Educate members of potential side effects to medication
Important Company members with information and advice on prescribed over the counter medication.
Perform administrative duties:
Improve areas identified by the QA team
Continue with ongoing Learning
And Development to stay abreastwithhealthcare industrychanges
Capture of accurate clinical records on system
Important Company effective communication to encourage and maintain behavioural change
Script to schedule 4, if and when clinically appropriate
Issue Sick notes if and when clinically appropriate
Adhere to time and attendance
Prioritize incoming authorization requests and/or queries according to urgency
Assess pre-authorisation requests for GP visits, specialist visits, emmergency room visits, diagnostic procedures, hospitalisation for illness and accident events, including the appropriate facilities day clinics, sub-acute facilities, home nursing and preferred providers
To check the reasons for authorisation and documentation received are appropriate and confirm if IT according to Important Company protocols, guidelines, formularies and preferred provider agreements. Based on protocols approved or decline. If the reason for authorisation is not defined in the protocols or guidelines escalate the case for clinical review
Approve or decline benefits accurately according to the benefits per benefit option and strictly according to the protocols