Pre-authorisation Consultant

2 weeks ago


Pretoria, South Africa RecruitForce Full time

Position**:Coordinator: Member Care**

**(Pre-Reporting to: Contact Centre Operational Manager)**

Location: On-site at the Head Office, Pretoria
- **Please Note: You will be required to work shifts between 7h00 and 19h00 (Monday to Sunday)**_ **Qualifications**:

- Registered/ Enrolled Nurse
- Valid registration with SANC

**Skills and Competencies Required**:

- Minimum 2-3 years’ experience in a similar role within a managed healthcare or medical scheme environment
- Sound knowledge of the South African Healthcare industry and prevailing legislation, current coding structures i.e. ICD10’s, CPT4, NRPL, PMB conditions and clinical protocols
- Thorough, well-grounded clinical knowledge of the pre-authorisation of hospital admissions (including Length of Stay and Level of Care), in-rooms procedures and other healthcare services requiring pre-authorisation
- Excellent telephonic and written communication capability within a call centre environment _(will be tested) _
- Computer literate _(will be tested) _- MIP Application System experience will be advantageous
- Customer service orientation
- Ability to liaise with external parties - clinicians and members - and to make decisions
- Demonstrated ability to effectively deal with emotionally charged and stressful situations
- Self-motivator and the ability to work effectively in an independent environment
- Good organisational and task prioritisation skills
- Outstanding multitasking skills
- Proficiency in English - written and verbal _(an additional language will be advantageous) _
- Ability to research and analyse information
- High degree of accuracy and attention to detail
- Compile and submit relevant reports in accordance with strict deadlines
- Results orientated
- Maintaining confidentiality of information

**Summary of Responsibilities**:

- Attend to incoming calls from healthcare service providers and members/ beneficiaries
- Verification of the eligibility of cover within available benefits as per scheme rules, clinical protocols, and funding guidelines
- Strict adherence to benefits, scheme rules, clinical protocols and funding guidelines across all services and authorisation categories
- Clinical Risk Management to reduce the risks associated with hospital and other authorised services
- Establish the presence of any co-morbid conditions from the caller or beneficiary if caller is not able to assist
- Refer to member management if co-morbid conditions are present for intervention and follow-up
- Attend to general enquiries
- Prepare and present cases for escalation to member management for discussion and resolution
- Provide member care and education to patients with and without chronic conditions who need to participate in any of the registered active disease management programs.

Pay: R25 000,00 - R32 000,00 per month


  • Medical Pre-Authorisation Consultant

    Found in: Talent ZA C2 - 3 weeks ago


    Pretoria, South Africa Qetello Holdings Full time

    Together with our client in Pretoria, we are recruiting for a Medical Pre-Authorisation Consultant. The ideal candidate must have a completed qualification as an Enrolled Nurse and must be registered with SANC, with at least 2 years experience in Managed Healthcare.Duties and responsibilities: Receive applications for all services, which require...


  • Pretoria, South Africa Recruitforce Group Full time

    Position: Coordinator: Member Care (Pre-authorisations) Reporting to: Contact Centre Operational Manager Location: On-site at the Head Office, Pretoria _**You will be required to work shifts between 7h00 and 19h00 (Monday to Sunday)**_ **Qualifications**: - Registered/ Enrolled Nurse - Valid registration with SANC **Skills and Competencies Required**: -...


  • Pretoria, South Africa Careforce Recruitment Full time

    **Position**:Member Care Clinical Consultant (Pre-authorisations) **Reporting to**: Operations Manager: Contact Centre **Location**:Head Office - Lynnwood, Pretoria (On-site) **Salary**: Market related CTC package that includes medical scheme and provident fund - **You will be required to work shifts between 07h00 and 19h00 (Monday to...


  • Pretoria, South Africa Careforce Recruitment Full time

    Position**:Member Care Clinical Consultant (Pre-authorisations)** Reporting to**:Operations Manager: Contact Centre Location: Head Office - Lynnwood, Pretoria **Salary**: Market related CTC package that includes medical scheme and provident fund **Qualifications**: - Registered/ Enrolled Nurse - Valid registration with SANC - _You will be required to work...


  • Pretoria, South Africa Recruitforce Group Full time

    Our client, a managed care organisation in Pretoria are currently looking for a Member Care Clinical Consultant (Pre-authorisations). - **You will be required to work shifts between 07h00 and 19h00 (Monday to Sunday).**_ **Reporting to**:Operations Manager: Contact Centre **Location**:Head Office - Lynnwood, Pretoria (On-site) **Salary**:Market related...


  • Pretoria, South Africa Mediro ICT Full time

    Applications operations support for Authorisations. Providing 1st level support to users; adhering to documented processes. Providing 2nd level support to processes where documented. Recording, routing, and monitoring all reported incidents using ITSM to ourclient’s incident management process. Liaising with other fix groups and other plant based or...

  • Healthcare Consultant

    23 hours ago


    Pretoria, South Africa Numsa Financial Services Full time

    Numsa Financial Services (NFS) is an authorised Financial Services Provider (FSP) accredited by the Financial Sector Conduct Authority (FSCA) and the Council of Medical Schemes (CMS). NFS was established in 2010, with the aim of providing members of the National Union of Metalworkers of South Africa(NUMSA) with affordable financial services products,...


  • Pretoria, South Africa Limpopo Personnel Full time

    **Essential skills**: - SAP BW Authorisations - SAP CRM Authorisations - SAP ERP Authorisation - SAP GRC **Advantageous**: - Functional knowledge of SAP Modules. - ABAP debugging beneficial (Workbench related knowledge of new development/enhancements). - Take consultative approach to challenge customers requested solution design, should a better...


  • Pretoria, South Africa JorDan Human Resources Full time

    2024-02-09 - 2024-03-09 - Permanent - JHB008837 - IT- Gauteng, Tshwane (Pretoria) - 1006_Operations Consultant Spanish Location: Gauteng Contract Term: 1 March 2024 - 31 December 2026 **ESSENTIAL SKILLS REQUIREMENTS**: - Fluent Business English (Verbal & written) - Fluent Business Spanish (Verbal & written) *** **ADVANTAGEOUS SKILLS...


  • Pretoria, South Africa Core Group Full time

    iStore is the home of everything Apple, and Africa’s largest Apple Premium Reseller. With a retail footprint of more than 30 physical and online stores across Africa that provide expert advice, Apple Authorised Repairs, Business, Education, training and technical support for anything and everything Apple. We are looking for tech savvy, retail inclined...

  • Insurance Consultant

    Found in: Talent ZA C2 - 1 week ago


    Pretoria, South Africa Santam Full time

    Who are we? Santam is the market leader in the general insurance industry in Southern Africa. We are a large, diversified, expanding and transforming company and whilst based in South Africa, we are rapidly moving into a number of emerging markets, both in Africa and Asia. Our success is rooted in our passion for our clients and everything we do is...


  • Pretoria, South Africa Careforce recruitment Full time

    Our client, a medical aid scheme in Pretoria are currently looking for a **Clinical Auditor/Snr Clinical Auditor. **This is a full-time hybrid position, and it will be expected of the successful individual to work at the office at least 3 days a week. About the role: To conduct clinical/coding audits according to the established internal, IIA and ISACA...


  • Pretoria, South Africa Financial Sector Conduct Authority Full time

    **Purpose of the Job** The Markets, Issuers and Intermediaries Department of the FSCA is responsible for licensing and supervising market infrastructures (i.e exchanges) operating within the South African financial markets in terms of the Financial Markets Act, 2012 (Act no 19 of 2012). The department has oversight responsibilities over public markets,...


  • Pretoria, South Africa JorDan Human Resources Full time

    2023-05-05 - 2023-05-31 - Permanent - JHB007608 - IT- Gauteng, Tshwane (Pretoria) - 2318_ **SAP Tax Consultant (Senior)** **Location: Gauteng** **Contract Term: 1 July 2023 - 31 December 2025** **ESSENTIAL SKILLS REQUIREMENTS**: - SAP Module Configuration and Customizing - Development documentation - Analyse and solve SAP Module issues - Conduct SAP...


  • Pretoria, South Africa International Water Management Institute Full time

    The International Water Management Institute (IWMI), a CGIAR Research Center, is at the forefront of addressing water-related challenges in agriculture, climate change, and resilience through groundbreaking research. As part of our ongoing commitment to enhancing water and climate resilience, IWMI is actively seeking a dedicated Consultant to contribute to a...


  • Pretoria, South Africa United Nations Development Programme (UNDP) Full time

    **LOCATION**: Pretoria, SOUTH AFRICA **TYPE OF CONTRACT**: Individual Contract **STARTING DATE**: **APPLICATION DEADLINE**: 11-Mar-24 (Midnight New York, USA) **POST LEVEL**: National Consultant **DURATION OF INITIAL CONTRACT**: 25 working days **TIME LEFT**: 7d 7h 53m **LANGUAGES REQUIRED**: English **EXPECTED DURATION OF...

  • SAP Ewm Consultant

    4 days ago


    Pretoria, South Africa Mediro ICT Full time

    Understand the business requirements, preparing AS-IS, and TO-BE documents and get sign-off from users for Business Blueprint document ABAP debugging beneficial (Workbench related knowledge of new development/enhancements) Setting up the organization structure of Materials Management and perform all relevant configuration for example Purchase Organisation,...

  • SAP Fico Consultant

    5 days ago


    Pretoria, South Africa Mediro ICT Full time

    Fair knowledge across all SAP modules. Initial focus on master data. Ability to assist with problem identification and possible solution by means of skills such as code debugging. **The following functional skills are essential**: Documentation of as-is and to-be business processes. Coordinate with other module SAP Consultants for Integration...

  • Junior Analyst

    5 days ago


    Pretoria, South Africa Financial Sector Conduct Authority Full time

    **Purpose of the Job**: The Markets, Issuers and Intermediaries Department of the FSCA is responsible for licensing and supervising market infrastructures (i.e exchanges) operating in the South African financial markets in terms of the Financial Markets Act, 2012 (Act no 19 of 2012). The department has oversight responsibilities over for public markets,...

  • 0040_ SAP FICO Consultant

    Found in: Talent ZA 2A C2 - 3 weeks ago


    Pretoria, South Africa Jordan HR Full time

    ESSENTIAL SKILLS REQUIREMENTS:· SAP FICO (SAP S/4 HANA advantageous)· SAP FIORI (Advantageous) ADVANTAGEOUS SKILLS REQUIREMENTS:· SAP MDG Master Data Governance (Advantageous)· German speaking (advantageous)· Flexibility to work some weekends / shifts or longer hours if required.· Experienced in Agile...