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Pre Authorisation Consultant - Registered Nurse

Vacancy Details

Reference No.

SP3-5866

Synopsis

An exciting opportunity for an analytical and attention-to-detail Pre- Authorisation Consultant exists in the Managed HealthCare group. The successful candidate will utilise their Clinical, Pre-Authorisation & Case Management experience to build effective relationships with our members telephonically. The position reports directly to the Service Manager: Managed HealthCare.

Description

  • Ensuring successful & smooth Pre-Authorisation and case management process telephonically in a call centre environment, on email and online chat.
  • Ensure adherence to Scheme Rules on all Hospital Authorisations and clinical updates
  • Ensure correct allocation of facilities for our Members
  • Effective handling of Internal/External Clinical Queries Communicate with members and service providers in order to address hospital utilisation matters 
  • Assist with Health Risk Management Monitoring & Management of hospital re-admissions
  • Compile & submit detailed reports to the Scheme on costs and patient’s progress

Requirements

  • A minimum of Grade 12
  • A Registered Nursing qualification.  
  • Intensive Nursing Science & Operating Theatre Techniques qualification will be an added advantage.
  • Previous exposure in Renal Dialysis, Oncology and/or Psychiatric environment would be most preferred
  • Exposure to Theatre and/or ICU in a private hospital will be an added advantage.
  • Sound knowledge of the Coding Systems: ICD10 & CPT4 Principles and sound knowledge of the Medical Aid Industry, Rules & Regulations, ISO and other related legislation
  • Previous exposure in a Managed Healthcare Call Centre
  • Excellent business writing & communication skills with exceptional telephone etiquette
  • Must have strong organisational awareness in order to anticipate the impact of actions on other groups.
  • Time Management & good administration skills
  • Effective conflict resolution skills and the ability to work under pressure
  • Must be a strong team player and results driven
  • Computer literacy (MS Office and Medical Administration system)

Position Type

Permanent

Work Level

Mid-Level

Salary

Market Related

Industry

Pharmaceutical And Medical/Healthcare

Salary Type

Annually

Package

Cost To Company

Affirmative Action

No

Geographic Location

Gauteng - Centurion