Medshield Medical Scheme Vacancies 2021 – Careers24 Medshield Medical Scheme Jobs @ www.medshield.co.za

Medshield Medical Scheme Vacancies 2021 | Medshield Medical Scheme Jobs Careers24 @ www.medshield.co.za. Medshield Medical Scheme Careers 2021. Vacancies with Medshield Medical Scheme South Africa.

Here you can get the latest Eastern Cape Government Jobs in Medshield Medical Scheme. Currently Medshield Medical Scheme Jobs in Port Elizabeth Available now. You can apply now Jobs in Medshield Medical Scheme Department. We will update you on this page for Gumtree jobs in Medshield Medical Scheme. So Candidates can subscribe to our South Africa Government Jobs Portal for Upcoming Government Vacancies 2021 in the Medshield Medical Scheme.

You can also get here Medshield Medical Scheme Matric jobs in Port Elizabeth & Upcoming jobs in Port Elizabeth for Matriculants.


Medshield Medical Scheme Vacancies 2021 | Medshield Medical Scheme Bank Jobs Opportunity for Manager

Medshield Medical Scheme Jobs notification out on official Medshield Medical Scheme Vacancies Page for Manager Job position. Job seekers who have B Pharm Degree qualification can apply for the Manager job position. The posting for the Medshield Medical Scheme Manager in Port Elizabeth. Salary – R418,265.00 Yearly.

Minimum Requirements…

Requirements
EXPERIENCE

-Minimum of 5 years experience in a managed care environment in a clinical expert role (Medicine Management, Disease Management, and Ambulatory Care Services)
-At least 3-5 years work experience in the design, implementation, and evaluation of quality/ cost-effectiveness improvement initiatives in a managed care clinical setting, as well project management experience

QUALIFICATION

-B Pharm Degree and be registered with the Pharmaceutical Society of South Africa

KNOWLEDGE

-Relevant legislation and regulatory frameworks
-Healthcare Industry Knowledge
-Clinical Risk management
-Medical Knowledge
-Business Acumen
-Technical problem-solving
-Financial budgeting and management processes
-Project Management

SKILLS

-Verbal and Written Communication
-Conflict Resolutions
-Presentations
-Project Management
-Coaching and Mentoring
-Negotiation
-Microsoft Office

ATTRIBUTES

-Innovative Thinking
-Customer Centric
-Results Focused
-Quality Focused
-Assertiveness
-Teamwork
-Problem Solving
-Judgement and Decision Making
-Analytical Thinking
-Flexibility and Adaptability
-Impact and Influence
-Emotional Maturity

Job Specification..

Specification

-Provide input into the development of the division’s strategy.
-Develop a supporting tactical plan for the Clinical Risk sub-division to ensure execution of the strategic objectives and goals.
-Drive the implementation of the tactical plan by developing and allocating operational activities, and ensuring alignment to the achievement of operational targets.
-Ensure the establishment, maintenance, and improvement of Standard Operating Procedures, policies, clinical protocols/guidelines/formularies/ to ensure that appropriate and cost-effective treatment is rendered to members in a measurable and consistent manner relating to the Clinical Risk division in consultation with the Executive: Operations.
-Use insights gained through business information to compile reports, and metrics to measure success and inform the business decision-making process and realign objectives.
-Monitor and continuously evaluate the progress of the division’s achievements against the tactical plan and strategic objectives
-Ensure overall provision of a cost-effective and competitive Medicine Management, Disease Management and Ambulatory Care Services
-Formulate the necessary disease management programs in collaboration with the Medical Advisor and offer clinical support and guidance where necessary
-Development and maintenance of performance measures to assess the quality of care in Medicine Management, Disease Management, and Ambulatory Care Services
-Investigate and provide high-level input into the resolution of escalated queries received from the Operations division and 3rd party managed care organisations to ensure effective feedback to members and in accordance with set SLA.
-Identify and target cost drivers in the Scheme’s healthcare expenses.
-Develop and implement a plan to manage and monitor the return on investments of recommended and/or approved networks.
-Evaluate the quality improvement activities of managed care organizations as per contractual agreement
-Offer input into the preparation of Council Appeals and Queries, PMB Queries, and Ex-gratia cases
-Assisting in the conceptualisation, planning, and implementation of new managed care products
-As part of a team, develops, implements, and executes management strategies with third party companies for compliance with standard guidelines, and scheme rules
-Ensure compliance with legal and procedural guidelines
-Performs other duties, ad hoc projects, and special assignments as required
-Provide input into the division’s risk register in consultation with the Manager: ARC.
-Ensure the mitigation of the division’s risk profile through the application of fraud controls and risk prevention principles and implementing sound governance and compliance processes and tools to identify and manage risks.
-Responsible for the coordination and maintenance of quality risk management in line with the requirements from ISO9001:2015.
-Monitor changes in the regulatory environment and ensures that appropriate operational controls are implemented to address new requirements.
-Support and provide evidence to all internal, external, and ISO audit requirements.
-Oversee the maintenance and enforcement of all technical-related Service Level Agreements to minimise business risk and ensure business continuity.
-Ensure adherence in the Clinical Risk team to all relevant laws, policies, and Standard Operating Procedures throughout the organisation.
-Provide input in the planning and compilation of the division’s annual budget aligned to the tactical delivery plans to support the implementation of set objectives.
-Ensure the effective implementation, management, monitoring of the division’s budget, and mitigate and report on any variances.
-Ensure the deployment of proper financial controls to manage the divisional budget.
-Report on and communicate any costs improvements and shortfalls.
-Build and lead an effective and cohesive team through the effective management of divisional resources.
-Drive the implementation of talent acquisition, succession planning, development, and retention strategies for the division.
-Ensure the enhancement of relevant knowledge and skills through continuous coaching, mentoring, and nurturing of divisional talent.
-Create a high-performance culture and manage team performance effectively by translating and communicating the annual performance goals and measures into individual work plans based on agreed-upon objectives.
-Ensure that the working environment contributes to improving employee engagement, recognition, and increased productivity.
-Ensure that management of poor performance and disciplinary matters is in line with the Schemes policies and procedures.
-Identify and mitigate internal systems and procedural barriers to enhance excellent customer service.
-Build and maintain effective internal and external stakeholder relationships for the purpose of expectations management, knowledge sharing, and integration.
-Represent and participate in the organisation’s committees and tasks teams when required.
-Convene and attend meetings and present findings and business cases to relevant stakeholders when required.
-Implement timeous communication on progress and challenges in achieving the tactical work plans to impacted stakeholders.
-Attend industry-related forums, conferences, and workshops to gain industry insight for the purpose of business improvement.

Medshield Medical Scheme Careers 24 Jobs Opportunity 2021

The Medshield Medical Scheme Careers 24 Jobs Opportunity 2021:- Medshield Medical Scheme is a leading Company in South Africa. Lots of South Africans crave to work with Medshield Medical Scheme. Medshield Medical Scheme offers many jobs every year. This is the dream job for South African people.

Thousands of candidates apply every year for the jobs left in Medshield Medical Scheme, but some candidates have successful addresses in this. Again this year, Medshield Medical Scheme is going to recruit a lot of jobs. This news is very important for the candidates who have been preparing for Medshield Medical Scheme recruitment for a long time.

Why Youth Need Only Medshield Medical Scheme Vacancies 

Why should you work in Medshield Medical Scheme? Medshield Medical Scheme is a leading organization that gives great respect to its employees. Employees who work in Medshield Medical Scheme are given a very good salary package. Apart from this, Medshield Medical Scheme offers its employees a weekly holiday. Medshield Medical Scheme has a great working environment. Along with this, you also get a promotion every year. Therefore you should work in Medshield Medical Scheme.

Opportunity at Medshield Medical Scheme Vacancies Portal 

Medshield Medical Scheme provides jobs for all youth. Youngsters who have passed Matric / Grade 12 can apply for clerk peon and other posts in this institution. Apart from this, graduate pass candidates can join the internship programs of Medshield Medical Scheme. Along with this, graduate and master degree holders can apply for big posts. Overall Medshield Medical Scheme makes jobs available for all categories.

How to Submit Medshield Medical Scheme Application form at Medshield Medical Scheme Vacancies Page

To apply for Medshield Medical Scheme Jobs, you have to follow the following steps.

  • First of all, you have to create your account on the official website of Medshield Medical Scheme.
  • After this, you will have to login to your account.
  • After account login, you have to select a job profile for yourself, remember that you should be eligible for that job profile.
  • Once you select the profile, you will have to fill the application form.
  • Fill the application form carefully.
  • After filling the form, click on the submit button and wait for the process to complete.
  • Candidates are advised to keep a print out of the application form with them so that they can be used when needed.

Apply For Vacancies at Medshield Medical Scheme


Medshield Medical Scheme Vacancies 2021 | Medshield Medical Scheme Bank Jobs Opportunity for Case Manager

Medshield Medical Scheme Jobs notification out on official Medshield Medical Scheme Vacancies Page for Case Manager Job position. Job seekers who have National Diploma in Nursing qualification can apply for the Case Manager job position. The posting for the Medshield Medical Scheme Case Manager in Port Elizabeth. Salary – R272,416.00 Yearly.

Minimum Requirements…

EXPERIENCE

-5 years of case management and disease management experience
-Minimum of 3 years experience in high-risk patient case management or care coordination program within a medical scheme or managed care environment.

QUALIFICATION

-National Diploma in Nursing (General, Community Health, Midwifery, and Psychiatry)
-Diploma in Intensive care an added advantage
-Registered Nurse (SANC)

KNOWLEDGE

-Medical Knowledge
-Good working knowledge of ICD10 coding and other clinical coding
-Clinical Risk management
-Risk Management practices and principles
-Relevant legislation and regulatory frameworks
-Medical Aid Industry
-Claims Assessing

SKILLS

-Verbal and Written Communication
-Project Management
-Managed healthcare
-Business Acumen

ATTRIBUTES

-Resilience
-Detail Orientation
-Innovative Thinking
-Customer Centric
-Results Focused
-Quality Focused
-Compliance Driven
-Analytical Thinking
-Problem Solving
-Judgement and Decision Making

Job Specification..

Specification

-Use prepared lists of potentially high-risk patients, identified and stratified according to the level of risk, to prioritize and schedule risk management interventions.
-Further provides hospital utilisation management, education/training, and other clinically based activities as assigned, to coordinate care between the medical scheme/managed care organisation, members, providers and the community
– Communicates with the admitting facility to establish the clinical status of the patient. – Communicates updates of level of care, length of stay and value to the hospital subject to the clinical guidelines and protocols of the scheme where.
-Ensure that all risk management interventions are patient-specific.
-Perform desk research to analyze the patient’s medical profile and claiming behavior to develop possible action plans to ensure that the patient is receiving the level and extent of care necessary for optimal management of his/her condition(s), possible action plans for improving patient adherence to treatment and possible action plans regarding lifestyle measures required to assist in mitigating the clinical risk.
-Engagement telephonically with patients to agree on strategies and specific, detailed action plans to improve the patient’s medical prognosis and optimal disease control.
-Identify areas where the member requires education and support and provide such.
-Engage with the third-party Managed Care Partners and Medical Providers to request specific health information to provide an update of a member’s healthcare status and facilitate registration on the appropriate programs and authorization of care baskets.
-Set achievable goals and targets for the member to achieve i.e. visit their doctor every 6 months, have specific investigations performed at scheduled dates, lose a specified number of kilograms in a defined time period, reduce their blood pressure to 120/80, reduce their HbA1c to a specific level by a certain date, etc.
-Ensure that the member understands how to take their medicines and the need to remain adherent to their treatment.
-Help the patient make any arrangements necessary to receive optimal care and to adhere to their treatment plan and schedule.
-Communicate with the patient’s provider when necessary to coordinate care.
-Identify if the patient needs to be referred to specialist care, or have a second opinion, and assist in facilitating or arranging this.
-Arrange for patients to join support groups, enroll on the Scheme’s exercise program, dietitian program, etc., as the case may be.
-Monitor and track adherence to the agreed action plan, per patient, through claims analyses and ongoing patient engagement.
-Engage telephonically with every identified patient at least once a month to ensure adherence to action plans.
-Engage and collaborate with the clinical team for support and advice where required
-Perform site visits, where required, for high-cost patients in hospital to contain costs and coordinate and arranging cost-effective care in collaboration with the treating Doctor and facilitate discharge planning.
-Arranges for the member to be transferred to an alternative facility when on-going care is required. – Refers patients to Disease Management, where appropriate, during a hospital admission
-Monitor and record all patient interactions and action plan goals to measure the success of the interventions.
-Produce reports (statistics) to demonstrate patient progress, patient outcomes, and pre-and post-intervention outcomes.
-This person will be responsible to effectively communicate and deliver an uncompromising quality of service to all internal and external customers by ensuring that all clinical updates and coding are of the highest standard.
-Ensure adherence to Scheme Rules on all authorisations and clinical updates where applicable.
-Assist with Health Risk Management Monitoring & Management of hospital re-admissions
-Compile & submit detailed reports to the Scheme on costs and patient’s progress
-Educate members on their chronic conditions via email or telephonically.
-Support the Clinical Manager and HOD on any projects related to risk management.
-Meet the required daily targets and daily operational delivery within the Clinical Risk Division according to set Service Level Agreements (SLA’s) and the Performance Contract.
-Develop and maintain a general clinical understanding of Tariff coding, ICD, CPT, SAMA, RPL and National Pharmaceutical Product Interface (NAPPI) codes, and how these affect clinical billing rules.
-Assist with the review of policies, protocols, tariffs, NAPPI codes from a clinical and financial position.
-Provide the Medical Advisor with supporting documents for motivation for additional services payments on special cases.
-Attend to complaints, queries, and escalations.
-Monitor outputs and results to inform process efficiencies to achieve targets.
-Accountable for adhering to and managing error rates according to the QA policy within the division.
-Develop and maintain adequate knowledge of data handling and ensure proper record keeping of related records.
-Be open to Multiskilling in other areas within clinical risk
-Contribute to the targeted research into local and international clinical guidelines and funding policies.
-Research medical literature and use evidence-based principles to generate enhancements in funding protocols. • Prepares, participates in interdisciplinary discussions and presents cases at clinical meetings. Prepares reports and case summaries as needed.
-Participate in clinical projects/special assignments which are instrumental to the department
-Assist with special requests on any clinical decision-making when required.
-Provide support in conducting year-end testing, and special projects when required.
-Provide knowledge and expertise of prevailing legislation within the funding environment.
-Application of Scheme Rules in all aspects, and updating of protocols.
-Assist in identifying and adhering to fraud controls, risk prevention principles, sound governance and compliance processes, and tools to identify and manage risks.
-Support and provide evidence to all internal, external, and ISO audit requirements.
-Maintain quality risk management standards in line with the requirements from ISO9001:2015.
-Maintain and enforce all clinical risk-related Service Level Agreements to minimize business risk and ensure business continuity.
-Review and amend all related Standard Operating Procedures in consultation with the Supervisor: Clinical Risk to ensure business optimization.
-Adhere to all relevant laws, policies, and Standard Operating Procedures throughout the organization.
-Treat information and documentation as private and confidential, and only disclose to any parties as according to the SOP’s and relevant regulations.
-Build and maintain effective internal and external stakeholder relationships for the purpose of expectations management, knowledge sharing, and integration.
-Liaise with Medical Advisor, other Clinical Managers to optimize the care of the member managers.
-Contacting members and building positive relationships with the members to achieve positive outcomes.
-Convene and attend meetings and present findings to relevant stakeholders when required.
-Liaise with members, brokers and healthcare professionals, and 3rd parties delivering exceptional customer service.
-Provide educational information to relevant parties on health conditions, treatment, and patient care.
-Provide input and support to the clinical committees, external advisory panel, and other committees as and when required.

Medshield Medical Scheme Careers 24 Jobs Opportunity 2021

The Medshield Medical Scheme Careers 24 Jobs Opportunity 2021:- Medshield Medical Scheme is a leading Company in South Africa. Lots of South Africans crave to work with Medshield Medical Scheme. Medshield Medical Scheme offers many jobs every year. This is the dream job for South African people.

Thousands of candidates apply every year for the jobs left in Medshield Medical Scheme, but some candidates have successful addresses in this. Again this year, Medshield Medical Scheme is going to recruit a lot of jobs. This news is very important for the candidates who have been preparing for Medshield Medical Scheme recruitment for a long time.

Why Youth Need Only Medshield Medical Scheme Vacancies 

Why should you work in Medshield Medical Scheme? Medshield Medical Scheme is a leading organization that gives great respect to its employees. Employees who work in Medshield Medical Scheme are given a very good salary package. Apart from this, Medshield Medical Scheme offers its employees a weekly holiday. Medshield Medical Scheme has a great working environment. Along with this, you also get a promotion every year. Therefore you should work in Medshield Medical Scheme.

Opportunity at Medshield Medical Scheme Vacancies Portal 

Medshield Medical Scheme provides jobs for all youth. Youngsters who have passed Matric / Grade 12 can apply for clerk peon and other posts in this institution. Apart from this, graduate pass candidates can join the internship programs of Medshield Medical Scheme. Along with this, graduate and master degree holders can apply for big posts. Overall Medshield Medical Scheme makes jobs available for all categories.

How to Submit Medshield Medical Scheme Application form at Medshield Medical Scheme Vacancies Page

To apply for Medshield Medical Scheme Jobs, you have to follow the following steps.

  • First of all, you have to create your account on the official website of Medshield Medical Scheme.
  • After this, you will have to login to your account.
  • After account login, you have to select a job profile for yourself, remember that you should be eligible for that job profile.
  • Once you select the profile, you will have to fill the application form.
  • Fill the application form carefully.
  • After filling the form, click on the submit button and wait for the process to complete.
  • Candidates are advised to keep a print out of the application form with them so that they can be used when needed.

Apply For Vacancies at Medshield Medical Scheme

Reason to visit Indeedjobs.co.za for Medshield Medical Scheme Vacancies 2021

Indeedjobs.co.za is a leading South African job site that assists jobseekers & Applicants from all Government vacancies sectors and experience levels to find and apply for Medshield Medical Scheme vacancies from thousands of South Africa’s leading companies Medshield Medical Scheme one of them. With over lots of website visitors a month, Indeedjobs.co.za is one of the most popular websites to find Government Jobs employment Indeed Jobs online in South Africa.

Indeedjobs.co.za Careers24 mission is to become a great website where every candidate can find an Indeed job and where every company can find the perfect candidate to join their company jobs. Indeedjobs.co.za is also a great website for Bank Vacancies South African youth to get jobs in various companies like Medshield Medical Scheme.

Vacancies at Medshield Medical Scheme | About Company