Talent Pool | MSOI Clinical Coordinator (Assistance)

Discovery Health | Africa Health Hub

Medical Services Organisation | Clinical Coordinator (Assistance)

About The Discovery Africa Team

Discovery Africa is a subsidiary of Discovery Health and strategically extends Discovery’s reach through delivery in key business activities:

Provision of Health insurance products underpinned by Vitality and Shared value principles, targeting growth across the African continent. Products are currently sold in: DRC, Mozambique, Kenya, Zambia, Ghana, Nigeria and Tanzania.

Third Party Administration services provided to global, multi-national insurance organisations. Coverage extends to all countries on the African continent (except CAR and Guinea Bissau)

24/7 Medical assistance to inbound travellers to South Africa and outbound travellers to the rest of the world. This includes Discovery Health members covered under the international travel benefit (ITB).

By applying for this role, you are consenting to be placed in our Talent Pool for future recruitment, should we have met our recruitment numbers.

What is a Talent Pool?

In simplest terms, a talent pool is a database of candidates that have already been deemed qualified for particular positions and who can be offered roles as soon as they become available.

What does this mean for you?

It’s good news because it means, you will still go through the recruitment process (assessments, role plays and interviews) and if you meet our minimum criteria, will be next in line for consideration as soon as we require more staff.

You will remain as an active candidate on our database and we will update you on progress on a monthly basis.

Key Purpose:

The Clinical Coordinator will work closely with the Clinical and Admin members of the international team to ensure alignment of activities as well as the achievement of client service level objectives. He/ she is also responsible for the management of all pre-authorisation and medical assistance requests for international health insurance members. He/ she will liaise with the Client’s services contact centre, service providers and other members of the multi-disciplinary team to ensure the best outcome for all members.

Key Outputs:

Duties and Responsibilities included but not limited for all MSO Companies and subsidiaries:

• Align clinical activities to the Strategic objectives of the Business Unit.
• Work closely with team members and all stakeholders to ensure alignment of activities with client SLA objectives. Manage the entire spectrum of activities from pre-authorization, case coordination, clinical review through to discharge planning, chronic disease management and/or repatriation.
• To work shifts and hours as specified by operational requirements. Flexibility is essential.
• Ensure that call centre service levels are met:

1. all ACD calls to be answered in less than 3 rings (under 20 seconds)
2. manage call talk time/ duration to an average of 180 seconds (3 minutes)

• Accept pre-authorisation requests telephonically, e-mail/fax:

1. verify membership validity
2. verify benefit available for treatment requested as per scheme/ Insurers benefit rules.

• Assess medical necessity of treatment, appropriateness of facility, service provider and level of care, refer to medical protocols, and consult with Clinical Manager /Medical Advisor as required or if uncertain.
• Approve /decline request and communicate appropriately with member/ service provider and Update cases based on utilisation review and clinical updates from hospital.
• Attend to daily tasks as delegated, i.e. mail-box, daily pending status reports and liaise with scheme contact people on funding decisions as required.
• Provide detailed feedback within the prescribed SLA time frame to clients.
• Co-ordinate on-site/telecom Case management visits as may be required from time-time to monitor, level of care, utilisation review, discharge planning / negotiation with hospital admin/ Treating Specialists.
• Provide detailed feedback within the prescribed SLA time frame to management.
• Liaise with clients and service providers as required and participate in delegated projects.

Competencies:

The successful candidate must demonstrate the following competencies:

Education and Experience:

EMPLOYMENT EQUITY   
                             
The Company’s approved Employment Equity Plan and Targets will be considered as part of the recruitment process. As an Equal Opportunities employer, we actively encourage and welcome people with various disabilities to apply.