Key Performance Areas Determine appropriate treatment once diagnosed.Perform administrative duties.Key Tasks Determine appropriate treatment once diagnosed.Establish member’s primary diagnosis based on signs and symptoms.Identify the most appropriate treatment plan according to Clinical Guidelines for the member.Communicate correct benefits and Product knowledge.Evaluation of first-time resolution of members calls.Action cases sent to Medical Consultant within the SLAEncourage appropriate OTC utilization.Encourage appropriate Acute Medication Benefit utilization.Deliver appropriate information to healthcare users.Educate members of potential side effects to medicationProvide members with information and advice on prescribed over the counter medication.Perform administrative duties.Improve areas identified by the QAContinue with ongoing Learning and Development to stay abreast with healthcare industryCapture of accurate clinical records on systemProvide effective communication to encourage and maintain behaviouralScript to schedule 4, when clinically appropriateIssue Sick notes when clinically appropriateAdhere to time andSecondary Tasks / ActivitiesPrioritize incoming authorization requests and/or queries according to urgency.Assess pre-authorisation requests for GP visits, specialist visits, emergency room visits, diagnostic procedures, hospitalisation for illness and accident events, including the appropriate facilities (day clinics, sub-acute facilities, home nursing and preferred providers)To check the reasons for authorisation and documentation received are appropriate and confirm if it according to set protocols, guidelines, formularies, and preferred provider agreements. Based on protocols approved or decline. If the reason for authorisation is not defined in the protocols or guidelines escalate the case for clinical reviewApprove or decline benefits accurately according to the benefits per benefit option and strictly according to the protocols.Other requirementsRegistered with SANCCall Centre experienceDispensing CertificateEssential QualificationsMatricNursing Diploma/DegreeDesirable QualificationsDispensing CertificateEssential Experience Experience in clinical evaluation of patient’s signs and symptomsIT system navigationDesirable Experience Primary HealthcareCall Centre experienceDispensing CertificateExperience in issuing of scripts as per regulationExperience in issuing of sick notes as per regulationKnowledge and Skills Extensive MS Office knowledgeStrong written and verbal communication skillsGood telephonic etiquetteGood listening skillsStrong administration skillsKnowledge in Primary HealthcareStrong organisation skillsGood time management skillsAttributes Holistic thinkerCritical thinkerAble to work under pressureTeam playerCompassionateHonest, hardworking, and humble#J-18808-Ljbffr