| Date | 2024-09-05 |
|---|---|
| Job Title | Professional Nurse: Clinical Auditor |
| Employer | More Information |
| Salary | Monthly |
| Category | Accounting Finance |
| Location |
Nelson Mandela Bay / Port Elizabeth |
Job Summary
Requirements:
A National Senior Certificate is essential. It is essential to have a Nursing Diploma or Degree. The incumbent must be registered with the South African Nursing Council (SANC) as a Registered Nurse. MS Office / Office 365 proficiency. Minimum of 2 yearsâ?? private hospital nursing experience. Previous exposure to clinical auditing. Examining information (interrogate claims data). Articulating information. Upholding standards. Attention to detail. Time management. Responsibilities and expectations but not limited to: Internal Process: Apply scheme rules, clinical policies and protocols to funding. Action allocated hospital claims for audit within department KPIs and CMS requirements for claims payment. Ensure accurate notes are made for all journals actioned on claims audited. Assess prosthesis for PMB funding when benefits are exceeded or if there is no benefit. Ensure accurate completion of authorisations on claim finalisation. Refer LOC/ LOS / item or drug approval queries to case managers for resolution. Act as clinical support to non-clinical hospital claim auditors in terms of hospital tariff applications and clinical guidance (e.g. procedures, devices and drug utilisation). Survey claims for correct application of tariff and refer discrepancies to the relevant team. Review retrospective claim approvals and send journal instructions for additional payments to the relevant team. Review hospital claims for clinical appropriateness, treatment authorised, over-usage of equipment/materials, application of billing rules and high-cost medication appropriateness. Customer Service: Investigate hospital claim queries within the agreed service level and ensure that the relevant stakeholder receives timeous feedback. Escalate queries to the relevant team or stakeholder. Provide accurate information and advice to stakeholders to ensure that they receive the appropriate service. Resolve claim queries accurately and timeously. Build and maintain relationships with internal and external stakeholders. Reduce claim rejections to ensure members are not held liable for unnecessary costs. People: Build strong relationships through expressing positive expectations. Continuously develop own expertise in terms of industry and subject matter development and application thereof in an area of specialisation. Contribute to continuous innovation through the development, sharing and implementation of new ideas and involvement of colleagues and staff. Participate and contribute to a culture of work centric thinking, productivity, service delivery and quality management. Finance: Identify opportunities to enhance cost effectiveness and increase operational efficiency. Manage financial and other company resources under your control with due respect. Provide input into the risk identification processes and communicate recommendations in the appropriate forum. Please note should you not receive a response within two weeks of applying you may assume that your application was unsuccessful.
Professional Nurse: Clinical Auditor position available in Nelson Mandela Bay, Port Elizabeth. This job position was posted by . The job has been posted on 2024-09-05 in the Accounting Finance category
Click Go Apply to apply online!
You might also like to look at the available jobs in the same area.
Apply directly for this position
Some posts have contact information included with other instructions. All applicants are urged to read the instructions carefully.
We will list jobs at the bottom of each job, so feel free to scroll down and continue your search.
We do not accept any job applications and merely offer the service of daily jobs being mined and displayed on our job portal.
Each job post has a link to take you directly to the original post to apply on their website or the original website where the post came from.
Here are some more related positions
Germiston: Professional Nurse (R/N) – Urgently Needed posted by Qualitas Services (PTY) LTD
Professional Nurses (R/N) required in Primrose, Germiston area.This will be for a possibly ongoing position. This will apply for Sisters who are currently unemployed.Send updated CV,ID and SANC receipt to Qualitas Services (PTY) LTD Professional Nurse (R/
View Job
Professional Nurse (R/N) – Urgently Needed
Ulundi: Professional Nurse/Nurse Clinician
MINIMUM REQUIREMENTS: Grade 12 Diploma/ Degree in Nursing (with Midwifery) OR Diploma in Midwifery Driver’s license (Preferable) Current Registration with SANC NIMART trained with Initiating experience PHC (Primary Health Care) experience Minimum 2 years’
View Job
Professional Nurse/Nurse Clinician
Kokstad: Professional Nurse
If you`re interested, please submit the following documents to infomobi-train.co.za or receptionmobi-train.co.za: Updated Curriculum Vitae (CV) All academic qualifications Identification Document (ID) or Passport South African Nursing Council (SANC) certif
View Job
Professional Nurse
South Africa: Professional Nurse (Student Health Services)
CORE PURPOSE OF JOB The purpose of this post is to plan, implement, provide and manage comprehensive Primary Health Care, HIVAIDS preventative, care and support, and Infectious Disease management to all students of the Nelson Mandela University in accorda
View Job
Professional Nurse (Student Health Services)
Cape Town City Centre: Senior Professional Nurse – Scrub
Job Description Deliver quality nursing care in collaboration with a multi-professional team Identify, prevent and manage risks to ensure patient safety Facilitate a positive patient experience by creating a conducive environment Provide accurate and compr
View Job
Senior Professional Nurse – Scrub
Cape Town City Centre: Professional Nurse
Job Description The successful candidates will be responsible for providing holistic and optimal quality nursing care to critically ill patients in order to maximize a positive outcome for the customer in line with Company & Hospital strategic objectives.
View Job
Professional Nurse
Port Elizabeth: Professional Nurse: Clinical Auditor
Requirements: A National Senior Certificate is essential. It is essential to have a Nursing Diploma or Degree. The incumbent must be registered with the South African Nursing Council (SANC) as a Registered Nurse. MS Office / Office 365 proficiency. Minimum
View Job
Professional Nurse
East London: Professional Nurse, East London
Applicants are required to meet the following criteria: Qualified in General Nursing Science and registered / licensed under the Nursing Act 3 yearsâ?? experience in a similar role Willing to work Night Shift on a rotational basis The successful applicant
View Job
Professional Nurse, East London
Randburg: Professional Nurse (R/N) – Urgently Needed posted by Qualitas Services (PTY) LTD
Professional nurse / (R/N) required in Randburg area.This is for an ongoing position. Mondays to Fridays from 08:00 to 16:00.No public holidays. Needs to be comfortable with insertion of drips. Other admin duties required but not limited.Send an updated CV
View Job
Professional Nurse (R/N) – Urgently Needed
South Africa: Professional Nurses With Phc
If you`re interested, please send the following to infomobi-train.co.za or receptionmobi-train.co.za 1. Updated CV 2. All qualifications 3. ID/Passport 4. SANC certificate 5. Bank statement 6. SARS certificate 7. Police clearance We look forward to hearing
View Job
Professional Nurses With Phc
Durban: Professional Nurse posted by Tower Group
MINIMUM REQUIREMENTS: Grade 12Diploma/ Degree in Nursing (with Midwifery) ORDiploma in MidwiferyCurrent Registration with SANC2 years experience in nursing after registrationNIMART certifiedIMCI certifiedDispensing LicenceProficiency in English & IsiZu
View Job
Professional Nurse
Ulundi: Professional Nurse posted by Tower Group
MINIMUM REQUIREMENTS: Grade 12Diploma/ Degree in Nursing (with Midwifery) ORDiploma in MidwiferyCurrent Registration with SANC2 years experience in nursing after registrationNIMART certifiedIMCI certifiedDispensing LicenceProficiency in English & IsiZu
View Job
Professional Nurse
Ulundi: Professional Nurse/Nurse Clinician posted by Tower Group
MINIMUM REQUIREMENTS: Grade 12Diploma/ Degree in Nursing (with Midwifery) ORDiploma in MidwiferyDrivers license (Preferable)Current Registration with SANCNIMART trained with Initiating experiencePHC (Primary Health Care) experienceMinimum 2 years experienc
View Job
Professional Nurse/Nurse Clinician
Durban: Professional Nurse posted by Tower Group
MINIMUM REQUIREMENTS: Grade 12Diploma/ Degree in Nursing (with Midwifery) ORDiploma in MidwiferyDrivers license (Manual)Current Registration with SANCNIMART trained with Initiating experience and certified as competent to work independently.NIMART mentor c
View Job
Professional Nurse
Ulundi: Professional Nurse
MINIMUM REQUIREMENTS: Grade 12 Diploma/ Degree in Nursing (with Midwifery) OR Diploma in Midwifery Current Registration with SANC 2 years’ experience in nursing after registration NIMART certified IMCI certified Dispensing Licence Proficiency in English &
View Job
Professional Nurse
Western Cape: Professional Nurses, Enrolled Nurses, Nursing Assistants posted by Mobitrain (Pty) Ltd
If you are interested, please visit our office in Bellville, Unit 27 Nobel Park Center.The following is required upon registration.Updated CVSANC 2024SANC CertificateDiplomas/DegreesID/PassportPolice ClearanceBank StatementSARS CertificateHepatitis B Certi
View Job
Professional Nurses, Enrolled Nurses, Nursing Assistants
Email Alerts
Click the button below and submit your email to receive email alerts with the latest jobs.
This service is offered by Result Generation
We do not save your information, and your email is the only information we forward to the service.
If you wish to unsubscribe, please click here
