CLINICAL CONSULTANT – Prosperity Health Namibia 13 views

Key Responsibilities

• 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.

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

How to Apply