Our client is recruiting for a Consultant: Medical Management who will be responsible for implementing the medical management activities, medical exception handling and providing administrative support in claims processing.

DUTIES & RESPONSIBILITIES Medical Management Conduct medical assessment and compile injury assessment reports. Conduct assessments and bill reviews on submitted claims, focusing on the appropriate level of care, the length of stay, and quality of care. Incorporate tariffs, cost savings initiative recording, and treatment protocol to ensure that all service providers adhere to the rules, and the tariff as guided by the organization and / or any that is considered reasonable. Pre authorise submitted claims aligned to the organization’s clinical guidelines including the formulary, treatment protocols and related tariffs. Escalation of complex cases for multi disciplinary review and adjudication. Participate in the consultations process on the implementation of...