Clinical Advisor
To provide clinical advice under the direction of the HCF Medical Director to support the business and implement HCF clinical governance policies. This involves liaising with hospitals, doctors, members and HCF staff regarding clinical issues relating to medical/surgical treatments, procedures and technologies with respect to memberships and products.
Job Responsibilities
- Review claims for clinical appropriateness and adherence to contractual eligibility. These include adherence to ICU guidelines, emergency treatment and 3B certificate reviews.
- Review claims and procedural requests in relation to Pre-existing Condition Legislation, under direction of the Medical Director.
- Overview of claims greater than a specified amount ($) with full written medical reviews that incorporates a thorough breakdown of the medical and surgical treatments provided including information on prosthesis and procedures.
- Provide a consultation service to other departments such as Ancillary Benefits Management and Products.
- Review and conduct clinical research for requests related to the provision of benefits outside the scope of the member’s policy product. This includes research to ascertain if a new treatment, drug or technology is clinically sound and effective.
- Clinically related complaints management
- Horizon scanning for new technology and practice trends
- Review of hospital services, facilities and treatment modalities for service providers applying for a hospital contract with HCF
- Clinical auditing of hospitals and other health care providers
Experience & Skills
Essential
- Registered nurse with recent hospital experience preferably with critical care experience
- Confident using computer systems
- Competency in Microsoft Word
- Ability to assimilate new data and to assess the veracity of medical information and reports
- Good interpersonal skills
Work Health and Safety (WHS) responsibilities
- Cooperate with HCF in relation to activities taken by the company to comply with WHS legislation
- Comply with WHS policies, procedures and safe work practices
- Adopt work practices that support WHS programs
- Ensure that any hazardous conditions, near misses and injuries are reported immediately to the manager
- Participate in meetings, training and other health and safety activities
- Not wilfully place at risk the health or safety of any person in the workplace
About HCF
At HCF, our purpose is to bring our human touch to healthcare. Since 1932 we’ve been putting our members and their health first. As Australia’s largest not-for-profit health fund, we cover over 1.9 million members with health, life, travel and pet insurance and our vision is to make healthcare understandable, affordable, high quality and member centric.
We want to be true health partners to our members, easily guiding the healthcare choices that are right for them. At HCF, our values are the way we do things and create the necessary culture to help us realise our purpose and deliver ourStrategy. Living our values in action we step forward, walk in their shoes, stay human, make it better and get there together.
Culture & Benefits
Purpose-driven passion
We’re united by a common purpose: to make healthcare affordable, understandable, high quality and member-focused.
Wellness and work-life balance
We’ll empower you with the necessary skills and tools to support your personal wellbeing journey, ensuring you perform at your best. Our offerings include:
- 50% subsidy on HCF hospital and/or extras cover
- 18 weeks of parental leave for all new parents
- Mental health and wellbeing programs, including workshops, fitness classes, flu vaccinations, skin checks and more
- Discounts on HCF’s products, including life, pet and travel Insurance, as well as discounts at Fitness First gyms and on our eyecare products.
Collaboration and inclusivity
We embrace diversity as our strength and are committed to maintaining an inclusive and collaborative work environment. Our workplace is welcoming and safe for all our employees, irrespective of their unique characteristics including age, ethnicity, cultural or spiritual background, gender identity, disability, education and socio-economic status.
Continuous learning and growth
We believe in lifelong learning. HCF provides opportunities for personal and professional development. From workshops to mentorship programs, we encourage your growth and curiosity.
Next steps
If you require any adjustments to assist you in making your application or during the recruitment or onboarding process, please reach out to Talent Acquisition – peopleservices@hcf.com.au to discuss.
We encourage applicants to submit their applications at their earliest convenience, as at HCF, we review applications as they are submitted, and may have filled the role prior to the job closing date.
To provide clinical advice under the direction of the HCF Medical Director to support the business and implement HCF clinical governance policies. This involves liaising with hospitals, doctors, members and HCF staff regarding clinical issues relating to medical/surgical treatments, procedures and technologies with respect to memberships and products.
Job Responsibilities
- Review claims for clinical appropriateness and adherence to contractual eligibility. These include adherence to ICU guidelines, emergency treatment and 3B certificate reviews.
- Review claims and procedural requests in relation to Pre-existing Condition Legislation, under direction of the Medical Director.
- Overview of claims greater than a specified amount ($) with full written medical reviews that incorporates a thorough breakdown of the medical and surgical treatments provided including information on prosthesis and procedures.
- Provide a consultation service to other departments such as Ancillary Benefits Management and Products.
- Review and conduct clinical research for requests related to the provision of benefits outside the scope of the member’s policy product. This includes research to ascertain if a new treatment, drug or technology is clinically sound and effective.
- Clinically related complaints management
- Horizon scanning for new technology and practice trends
- Review of hospital services, facilities and treatment modalities for service providers applying for a hospital contract with HCF
- Clinical auditing of hospitals and other health care providers
Experience & Skills
Essential
- Registered nurse with recent hospital experience preferably with critical care experience
- Confident using computer systems
- Competency in Microsoft Word
- Ability to assimilate new data and to assess the veracity of medical information and reports
- Good interpersonal skills
Work Health and Safety (WHS) responsibilities
- Cooperate with HCF in relation to activities taken by the company to comply with WHS legislation
- Comply with WHS policies, procedures and safe work practices
- Adopt work practices that support WHS programs
- Ensure that any hazardous conditions, near misses and injuries are reported immediately to the manager
- Participate in meetings, training and other health and safety activities
- Not wilfully place at risk the health or safety of any person in the workplace
About HCF
At HCF, our purpose is to bring our human touch to healthcare. Since 1932 we’ve been putting our members and their health first. As Australia’s largest not-for-profit health fund, we cover over 1.9 million members with health, life, travel and pet insurance and our vision is to make healthcare understandable, affordable, high quality and member centric.
We want to be true health partners to our members, easily guiding the healthcare choices that are right for them. At HCF, our values are the way we do things and create the necessary culture to help us realise our purpose and deliver ourStrategy. Living our values in action we step forward, walk in their shoes, stay human, make it better and get there together.
Culture & Benefits
Purpose-driven passion
We’re united by a common purpose: to make healthcare affordable, understandable, high quality and member-focused.
Wellness and work-life balance
We’ll empower you with the necessary skills and tools to support your personal wellbeing journey, ensuring you perform at your best. Our offerings include:
- 50% subsidy on HCF hospital and/or extras cover
- 18 weeks of parental leave for all new parents
- Mental health and wellbeing programs, including workshops, fitness classes, flu vaccinations, skin checks and more
- Discounts on HCF’s products, including life, pet and travel Insurance, as well as discounts at Fitness First gyms and on our eyecare products.
Collaboration and inclusivity
We embrace diversity as our strength and are committed to maintaining an inclusive and collaborative work environment. Our workplace is welcoming and safe for all our employees, irrespective of their unique characteristics including age, ethnicity, cultural or spiritual background, gender identity, disability, education and socio-economic status.
Continuous learning and growth
We believe in lifelong learning. HCF provides opportunities for personal and professional development. From workshops to mentorship programs, we encourage your growth and curiosity.
Next steps
If you require any adjustments to assist you in making your application or during the recruitment or onboarding process, please reach out to Talent Acquisition – peopleservices@hcf.com.au to discuss.
We encourage applicants to submit their applications at their earliest convenience, as at HCF, we review applications as they are submitted, and may have filled the role prior to the job closing date.
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