COMPANY VACANCIES Vacancies

Medical Management Consultant Vacancies (X5 Posts) at the Road Accident Fund (RAF)

Medical Management Consultant Vacancies (X5 Posts) at the Road Accident Fund (RAF)

 

 

The Road Accident Fund (RAF) invites suitably qualified applicants to apply for their Medical Management Consultant Vacancies (X5 Posts). The closing date for applications is the 11th February 2025

POSTS: MEDICAL MANAGEMENT CONSULTANT X5

  • Division: Operations
  • Reference No: 5150
  • Location: Durban, Kwazulu-Natal, ZA
  • Employment Type: Fixed Term Contract
  • A.S.K Grade: 11
  • Job Posting Salary: R501,775.00

PURPOSE OF THE JOB:

The Consultant: Medical Management is responsible to implement the medical management activities, medical exception handling and providing administration support in claims processing.

KEY PERFORMANCE AREAS:

Medical Management.

  • Conduct medical assessment and compile injury assessment reports.
  • Conduct assessments and bill reviews on submitted claims, focusing on the appropriate level of care, the length of stay, and quality of care.
  • Incorporate tariffs, cost savings initiative recording, and treatment protocol to ensure that all service providers adhere to the rules, and the tariff as guided by the RAF and / or any that is considered reasonable.
  • Pre authorise submitted claims aligned to RAF clinical guidelines including the RAF formularory, treatment protocols and related tarrifs.
  • Escalation of complex cases for multi disciplinary review and adjudication.
  • Participate in the consultations process on the implementation of medical claims processes.

 

 

Exception Handling.

  • Ensure the implementation and maintenance of a formal exception handling process within the medical management.
  • Maintain the documentation and regular updating of the exception handling process.
  • Maintain the implementation an unusual occurrence procedures.

Reporting.

  • Track and report against set objectives and targets.
  • Report on emerging risks.
  • Provide ad hoc reports on process improvement initiatives.
  • Produce documents, briefing papers, reports and presentations.

Stakeholder Management

  • Deal with/and respond to correspondence.
  • Maintain healthy relationships with all stakeholders.
  • Follow up and resolve all queries, following up and making recommendations on which corrective actions are appropriate.
  • Follow up and feedback to all stakeholders to keep them updated on the status of a query.
  • Respond to queries within the predefined turnaround times.

QUALIFICATIONS:

  • Bachelor’s Degree/Advanced Diploma in Health Sciences /Medical related qualification.
  • Registration with HPCSA/SANCA.

Experience:

  • Relevant 3 years’ experience in a Medical related environment.

Technical and behavioral competencies required:

  • Claims management process/ processes and systems.
  • Medical product management
  • Medical bill reviewing
  • Medical case management
  • Complex problem identification, solving and decision making
  • Customer value proposition
  • Strong clinical analytical capabilities
  • Knowledge of motor vehicle accident legislation
  • Planning, Organising and Coordinating
  • Personal Mastery
  • Judgement and Decision Making
  • Ethics and Values
  • Client Service Orientation

APPLICATIONS:

 

APPLY FOR THE MEDICAL MANAGEMENT CONSULTANT VACANCIES AT THE RAF HERE

 

CLOSING DATE: 11 FEBRUARY 2025

EDUPSTAIRS IS A REGISTERED NON-PROFIT ORGANISATION NPO No: 232 – 182, PUBLIC BENEFIT ORGANISATION (PBO): 930066984. EDUPSTAIRS DOES NOT, IN ANY WAY OR FORM, SOLICIT MONEY OR CV’S FROM PEOPLE FOR JOBS. PLEASE BE AWARE OF PHONY JOB POSTINGS AND RECRUITMENT FRAUD. FOR MORE INFORMATION VISIT OUR SCAM/FRAUD ALERT PAGE HERE

 

 

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