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We are currently working exclusively with our global healthcare insurance client to create a brand-new division. This will be a clinical provider team to help negotiate rates and partnerships in real time with providers based off clinical standards and medical codes of practice.
We are searching for 3 positions. 1 Team Lead, and 2 Team members.
Key Responsibilities
- Act as an internal clinical consultant, collaborating with multi-disciplinary teams to enhance patient outcomes.
- Evaluate clinical information to determine the appropriateness of care.
- Conduct detailed case reviews and advise on complex medical decisions.
- Monitor in-patient services to ensure adherence to clinical guidelines.
- Promote evidence-based practice across all levels of care.
- Facilitate effective communication between healthcare providers, patients, and external partners.
- Ensure smooth transitions and continuity of care.
Qualifications
- Experience with provider management and TPA’s and ability to communicate effectively with partners.
- Registered healthcare professionals with nursing background are preferred
- Proven expertise in clinical governance and case management.
- Up-to-date knowledge of medical best practices, health regulations, and quality standards. Knowing Medical Codes is a MUST
- Strong analytical skills with the ability to make informed, ethical decisions under pressure.
Skills
- Excellent interpersonal and communication abilities.
- Capability to influence and advocate for patient care improvements across different organisational levels.
- Proficiency in clinical documentation with meticulous attention to detail.
- Experience with electronic medical record systems and other healthcare technologies is highly regarded.
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