CLINICAL CONSULTANT – WINDHOEK

Prosperity Life Namibia

About the role

The successful incumbent will report to the Manager: Managed Health Care. The incumbent must be well motivated and positive with strong risk compliance/internal audit, administrative, analytical and communication skills, and a self-starter who can work independently and in a group.The company is passionately enveloped within the financial services sector, growing our business against the backdrop of enhancing the well-being of the Namibian populace.In furtherance of Prosperity’s purpose, the company seeks to attract dynamic and talented people who share our ideals and values, eager to expand their horizons within the realm of the Prosperity family. **Special Requirements:** • Grade 12 with Professional nurse qualification, registered with the Healthcare Professions Council of Namibia • Three years of demonstrated clinical experience • Three years of administrative experience, including in clinical protocols • Professional communication skills • Implementation and understanding of clinical protocols • Results-driven and focused • Ability to work independently, manage multiple priorities and maintain confidentiality • Flexibility to participate in an after-hours standby and support arrangements • Proficiency in Microsoft Office Suite **Company Contact:** Address: c/o Feld & Thorer Street Windhoek, KH, Namibia Phone: 061-2999000 Website: http://

Requirements

• [KEY FUNCTIONS:]
• Manage the receipt, capturing, processing, and administration of medical authorisations, including patient benefit management, clinical assessments, hospital admissions, and disease management in accordance with approved procedures.
• Ensure compliance with clinical protocols, fund rules, benefit structures, and applicable managed care policies.
• Assess and manage assigned cases by reviewing clinical information, authorising hospital admissions, and coordinating patient care in line with approved treatment plans.
• Communicate benefit decisions and authorisation outcomes to Members and Healthcare Professionals in a clear, accurate, and professional manner.
• Provide telephonic authorisation support for emergency cases and after-hours queries, ensuring timely clinical decision-making.
• Process, monitor, and maintain accurate records of Member cases received from Healthcare Professionals to ensure compliance with agreed service level standards.
• Communicate clinical decisions, authorisation outcomes, and recommendations to relevant stakeholders, including Members and Healthcare Professionals.
• Identify clinical exceptions and high-risk cases requiring escalation and facilitate appropriate intervention in accordance with established protocols.
• Build and maintain effective professional relationships with Members and Healthcare Professionals through proactive engagement and service excellence.
• Provide clinical expertise, input, and recommendations for managed care reporting, case reviews, and continuous process improvement initiatives

Source: Otjizu Jobs admin import