Jobs Opening at FEM

• This position is aimed at a dynamic and performance driven individual who can deliver administrative and clinical outputs whilst working effectively with people.
• The successful candidate will apply their clinical knowledge in the risk management of patients in terms of length of stay, level of care and other benefits in terms of the Compensation for Occupational Injuries and Diseases (COID) Act and other relevant guidelines.
• Furthermore, they will monitor serious cases of hospital admissions and clinical escalated queries as well as provide pre-authorisation of procedures not covered by the COID Act.
• The minimum requirements of the position are a Relevant B-degree / diploma with active registration as a Registered Nurse with SANC.
• The candidate must have at least 3 years' experience post qualification experience in ICU or Theatre Techniques, with at least 2 years’ experience in Case Management. Good functional computer literacy, good literacy and numeracy skills, an excellent performance track record as well as extensive knowledge of hospital billing rules, industry tariffs (including ICD10 Codes, UPFS, CPT4 Coding, SEP, NAP and PMB’s) are further requirements of the job. Coupled with the above, a valid driver’s license is part of our minimum requirements.
• Experience in a private hospital managed healthcare environment and knowledge of the COID Act and workman's compensation will be a distinct advantage. Excellent customer focus, the ability to work in a highly pressurized environment, quality orientation, reliability and excellent communication complete our requirements.

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• This role involves directing and managing medical management within claims operations, including medical assessments, claim payments, rehabilitation, reintegration, and return-to-work processes.
• The incumbent will analyse medical management trends and develop, review, and implement policies, procedures, and processes.
• Additionally, the position provides oversight and guidance for all complex claims escalated to the Head of Clinical Services.
• The successful candidate will be expected to establish positive working relationships with healthcare providers, stay updated with medical technology, innovation, and the latest clinical information, and provide strategic input into annual planning and budget development to support strategic operational and individual performance objectives.

Minimum Requirements:

• Must be a qualified doctor with an MBChB degree, registered with the HPCSA.
• Over 10 years of clinical experience in a hospital or private practice setting, with healthcare management experience.
• More than 5 years of management experience, overseeing a team of 10 or more people.
• Previous experience in the medical aid industry is advantageous.
• Knowledge of the Compensation for Occupational Injuries and Diseases Act (COIDA) is also beneficial.
• Ability to collaborate effectively with the team and drive optimal performance.