Clinical Review Nurse - L2A

SUMMARY:

Our client, a company who aims to bridge the gap between digital expectations and real outcomes for various companies with Digital Intelligence, seek to employ Clinical Review Nurses at their offices in the CBD of Cape Town.

POSITION INFO:

FUNCTION

• Reviews documentation and evaluates potential quality of care issues based on clinical policies and benefit determinations
• Considers all documented system information as well as any additional records/data presented to develop a determination or recommendation
• Data gathering requires navigation through multiple system applications
• Staff may be required to contact the providers of record, vendors, or client departments to obtain additional information
• Evaluates documentation/information to determine compliance with clinical policy, regulatory and
• accreditation guidelines
• Accurately applies review requirements to assure case is reviewed by a practitioner with clinical expertise for the issue at hand
• Commands a comprehensive knowledge of complex delegation arrangements, contracts (member and provider), clinical criteria, benefit plan structure, regulatory requirements, company policy and other processes which are required to support the review of the clinical documentation/information
• Pro-actively and consistently applies the regulatory and accreditation standards to assure that activities are reviewed and processed within guidelines
• Condenses complex information into a clear and precise clinical picture while working independently
• Reports audit or clinical findings to appropriate staff or others in order to ensure appropriate outcome and/or follow-up for improvement as indicated

EDUCATION REQUIREMENTS

• S. Nursing Graduate
• SA Registered Nurse

WORK EXPERIENCE REQUIREMENTS

• 2-3 years Clinical Experience
• Practical experience in areas of acute care, emergency room, cardiology, radiology, etc
• Managed Care experience preferred

Should you meet all the requirements and wish to apply for this role, please send your latest CV and motivation to --------Please upload your CV here-------->

 

NB! This job is now closed. You can apply for other jobs by uploading your CV.

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