Medical Review Assistant in PH

The Medical Review Team (MRT), provide high level support to case managers by delivering a range of specialised administrative services to assist case managers apply a best practice approach to managing medical treatment or services.

  • Processes which will be completed by the MRT include;
    Summarising medical reports
  • Providing a high level summary to employers of relevant information to assist with rehabilitation and return to work activities
  • Reviewing treatment requests against the application of the clinical framework
  • Claim reviews of identified cohorts of claims (i.e. high cost claims) to assist identify claim strategies for the ongoing management of the claim
  • Providing targeted questions to the relevant providers (treating and IME doctors, allied health providers etc.) which are focused on the claims circumstances
  • Produce professional claim summaries (briefs to doctors) with relevant targeted questions for providers.

The successful applicant will be required to review information in the Pivotal claim management system, eDocs and other relevant sources of information. Collate and summarise this information in the required format and within agreed timeframes.

RESPONSIBILITIES

  • Provide a comprehensive review of medical treatment to date and measure this against the clinical framework and MDGuidelines
  • Ability to provide a course of action to assist the case manager progress the required claim strategy
  • Review medical information, summarise this information and redact any information not to be released as required
  • Formulate targeted questions specific to the claim situation for providers
  • Assess claims against the clinical framework and MDGuidleines providing strategies to assist with ongoing case management activities

CAPABILITIES

  • A high level of competency in English language both in comprehension and verbal skills, including correct spelling, grammar and punctuation
  • Ability to interpret and analyse medical information
    Attention to detail
  • Confidentiality
  • Ability to deliver work in a timely manner
  • Limited decision making skills within a predefined matrix of requirements or process
  • Ability to liaise with case managers and operational teams
  • Working knowledge of the Microsoft Office suite of programs
  • Ability to understand and identify data using this to draw conclusions and choosing the correct course of action
  • Ability to follow processes to achieve a required outcome / conclusion
  • Ability to understand and assess aspects of a claim as required
  • Ability to accurately identify documents, interpret information and provide high quality summaries as required
  • Good troubleshooting skills
  • Ability to review data for deficiencies or errors, correct any inaccuracy’s and check output

JOB REQUIREMENTS

  • An undergraduate health-related tertiary qualification such as Occupational Therapy, Physiotherapy, Exercise Physiology, Rehabilitation Counselling, Psychology, Social Work, or Health Science.
  • Certificate/qualification in health management.
  • Experience in a health-related administrative setting
  • Experience working in an administrative or clinical rehabilitation setting