Our client is looking to onboard a Nurse Advisor to provide medical case management support for emergency assistance cases in line with Medical Panel best practices and established clinical procedures. Review medical cases using the information received to ensure accurate, clear, and timely guidance is delivered to the Operations team and external medical escort providers.
Responsibilities
Conduct medical triage by reviewing initial diagnoses and assessing patient requirements, including urgency, level of care, and location considerations
Authorise medical investigations, treatments, surgeries, and hospital admissions in straightforward cases, including MRI and CT scans
Provide guidance on the most appropriate treatment pathway in straightforward cases, considering insurance coverage, pre-existing conditions, and policy terms
Escalate or refer cases to external clinical advisors when required
Review and assess medical reports and updates received from healthcare providers
Monitor patient progress throughout treatment to ensure appropriate standards of care and service quality are maintained, making decisions within scope and referring complex matters to medical professionals when necessary
Support the coordination of medical evacuations and repatriations
Identify and advise on potential policy breaches by requesting and reviewing past medical history and medical declarations where appropriate
Review potentially fraudulent or excessive medical invoices to assess medical necessity, treatment appropriateness, and cost accuracy
Ensure all medical information and case updates are accurately recorded within the case management system
Maintain compliance with all applicable regulatory and confidentiality requirements, including patient data protection
Support management in identifying and mitigating departmental risks
Carry out all duties in accordance with company policies, acting with honesty and integrity, and reporting any suspected fraud or corruption
Adhere to all company policies and procedures, including Health & Safety, Equal Opportunities, Data Protection, Code of Conduct, Security, IT, and Internal Financial Controls
Undertake any additional duties or responsibilities reasonably assigned by management or the Company’s Senior Leadership Team
Requirements
Must be a State Registered Nurse or Registered General Nurse
Minimum of 3 years nursing experience, collaborating with medical doctors
Good understanding of local and international regulations, including Treating Customers Fairly principles
Capable of managing critical situations effectively while providing practical and straightforward solutions
Sound judgement, decision-making, and problem-solving abilities are essential
Ability to work both independently and collaboratively within a team environment
Ability to identify issues quickly and determine the most appropriate course of action in line with departmental procedures and guidelines
Excellent verbal & written communication skills in English, with a high level of accuracy and attention to detail
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