HR Practitioner | Affinity Health

Affinity Health Job Vacancies – HR Practitioner

A Medical Insurance Company based in Benoni is seeking a Registered Nurse to consult with members via relevant platforms, providing diagnoses and treatment plans according to Primary Healthcare Guidelines. Ensuring best clinical practice and quality is maintained for all members, while adhering to service level agreements.

Key Performance Areas

• Determine appropriate treatment once diagnosed.
• Perform administrative duties.

Key Tasks

Determine appropriate treatment once diagnosed:

• Establish members’ primary diagnoses based on signs and symptoms.
• Identify the most suitable treatment plan according to Clinical Guidelines.
• Communicate correct benefits and product knowledge.
• Evaluate first-time resolution of member calls.
• Take action on cases sent to Medical Consultant within the SLA.
• Encourage appropriate utilization of over-the-counter (OTC) and acute medication benefits.
• Provide accurate information to healthcare users.
• Educate members on potential side effects of medication.
• Offer advice on prescribed over-the-counter medication.

Perform administrative duties:

• Address areas identified by Quality Assurance (QA) for improvement.
• Engage in ongoing Learning and Development to stay updated with the healthcare industry.
• Accurately capture clinical records on the system.
• Provide effective communication to encourage behavioral adherence.
• Schedule follow-up appointments when clinically appropriate.
• Issue sick notes when clinically necessary.
• Adhere to allocated time frames.

Secondary Tasks / Activities

• Prioritize incoming authorization requests and/or queries based on urgency.
• Assess pre-authorization requests for various medical visits and procedures.
• Ensure documentation received aligns with established protocols, guidelines, and agreements.
• Approve or decline benefits accurately according to established protocols.

Other Requirements

• Registered with the South African Nursing Council (SANC).
• Call center experience.
• Dispensing Certificate.

Essential Qualifications

• Matric
• Nursing Diploma/Degree

Desirable Qualifications

• Dispensing Certificate

Essential Experience

• Experience in clinical evaluation of patients’ signs and symptoms.
• IT system navigation.

Desirable Experience

• Experience in primary healthcare.
• Call center experience.
• Dispensing Certificate.
• Experience in issuing scripts and sick notes as per regulation.

Knowledge and Skills

• Proficient in MS Office.
• Strong written and verbal communication skills.
• Good telephonic etiquette.
• Active listening skills.
• Strong administration skills.
• Knowledge of Primary Healthcare.
• Strong organizational and time management skills.

Attributes

• Holistic thinker
• Critical thinker
• Ability to work under pressure
• Team player
• Compassionate
• Honest, hardworking, and humble