Pre Authorisations Consultant

6 months ago

Pretoria, South Africa iMedrecruit Full time

About the job Pre Authorisations Consultant

**Pre-authorisations Consultant, Pretoria**

Our client, focusing on a risk and clinical assessment offering, is requiring a Pre-Authorisations Consultant.

**Roles and Responsibilities (but not limited to)**:

- 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.
- Loading authorisations
- 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 (case management) if co-morbid conditions are present for intervention and follow-up.
- Prepare and present cases for escalation to member management for discussion and resolution.
- Provide member care and education to patients

**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. ICD10s, 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
- 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

**Qualifications**:

- Registered/ Enrolled Nurse
- Valid registration with SANC

**Hours**:
Shift work between 7h00 and 19h00 (Monday to Sunday).

**Required**:
ASAP

  • Clinical Pre-Authorisation Consultant

    3 weeks ago

    Pretoria, South Africa Jobted ZA C2 Full time

    Our client is seeking a Clinical Pre-Authorisation Consultant to join their dynamic team. If you're a healthcare professional registered with the South African Nursing Council (SANC) as a Registered Nurse or Enrolled Nurse, with at least two years of experience in Managed Healthcare or Private Hospital settings, we encourage you to apply! Key...

  • Pre Authorisations Consutlant

    6 months ago

    Pretoria, South Africa iMedrecruit Full time

    **Pre-authorisations Consultant, Pretoria** Our client, focusing on a risk and clinical assessment offering, is requiring a Pre-Authorisations Consultant. **Roles and Responsibilities (but not limited to)**: - Attend to incoming calls from healthcare service providers and members/ beneficiaries. - Verification of the eligibility of cover within available...

  • Clinical Pre-Authorisation Consultant

    3 weeks ago

    Pretoria, South Africa Qetello Holdings Full time

    Our client is seeking a Clinical Pre-Authorisation Consultant to join their dynamic team. If you're a healthcare professional registered with the South African Nursing Council (SANC) as a Registered Nurse or Enrolled Nurse, with at least two years of experience in Managed Healthcare or Private Hospital settings, we encourage you to apply! Key...

  • Clinical Pre-Authorisation Consultant

    3 weeks ago

    Pretoria, South Africa Qetello Holdings Full time

    Our client is seeking a Clinical Pre-Authorisation Consultant to join their dynamic team. If you're a healthcare professional registered with the South African Nursing Council (SANC) as a Registered Nurse or Enrolled Nurse, with at least two years of experience in Managed Healthcare or Private Hospital settings, we encourage you to apply!Key...

  • Pre-authorisation Consultant

    6 months ago

    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**: -...

  • Pre-authorisation Consultant

    6 months 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...

  • Pre-authorisation Consultant

    6 months ago

    Pretoria, South Africa HRInsync Full time

    **Pre-Authorisation Consultant** **Introduction** One of the largest private Medical Aid companies in SA. They have been providing healthcare to the lives of South Africans for over 56 years. And are striving to be #1 in SA. **Purpose** Delivering cost-effective managed healthcare services to accomplish member satisfaction. **Duties &...

  • Medical Pre-Authorisation Consultant

    6 months 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...

  • Medical Pre-Authorisation Consultant

    6 months 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...

  • Medical Pre-Authorisation Specialist

    2 days ago

    Pretoria, Gauteng, South Africa Qetello Holdings Full time

    Job Title: Medical Pre-Authorisation SpecialistIn collaboration with our esteemed client in Pretoria, Qetello Holdings is recruiting a skilled Medical Pre-Authorisation Specialist. The ideal candidate must possess a completed qualification as an Enrolled Nurse and be registered with SANC, boasting at least 2 years of experience in Managed Healthcare.The...

  • Junior Pre-authorisation Consultant

    3 months ago

    Pretoria, South Africa Medpharm Recruitment Full time

    A reputable Medical Aid is seeking a Pre-Authorisation Consultant to join their Hospital Benefit Management team in Pretoria. **What will you be doing in this role?** - You will work in a Call Centre, answering calls on a daily basis and you will provide Members and/or Service Providers with Authorisation, for clinical procedures in hospital. (Training will...

  • Pre-authorisation Consultant

    6 months ago

    Pretoria, South Africa Medpharm Recruitment Full time

    A reputable Medical Aid is seeking a Pre-Auth Consultant to join their Call Centre team in Pretoria. A reputable Medical Aid Scheme, based in Pretoria, is seeking a Pre-Authorisation Consultant to join their Hospital Benefit Management team. **Duties**: - Delivering cost-effective managed healthcare services to accomplish member satisfaction. - Assisting...

  • Healthcare Authorisation Consultant

    2 days ago

    Pretoria, Gauteng, South Africa Qetello Holdings Full time

    About the Role:We are seeking a highly skilled Healthcare Authorisation Consultant to join our team in Pretoria. The ideal candidate must hold a completed qualification as an Enrolled Nurse and be registered with SANC, boasting at least 2 years of experience in Managed Healthcare.The successful candidate will be responsible for reviewing and processing...

  • Healthcare Pre-Authorisation Specialist

    1 month ago

    Pretoria, Gauteng, South Africa Qetello Holdings Full time

    Job Title: Healthcare Pre-Authorisation SpecialistLocation: Pretoria, South Africa

  • Pre-authorisation Consultant

    7 months ago

    Pretoria, South Africa Medpharm Recruitment Full time

    A reputable Medical Aid Scheme, based in Pretoria, is seeking a Pre-Authorisation Consultant to join their Hospital Benefit Management team. **Duties**: - Delivering cost-effective managed healthcare services to accomplish member satisfaction. - Assisting the Client by approving appropriate funding. - Delivering an effective Call Centre service in order to...

  • Medical Consultant: Pre-Authorization Expert

    1 month ago

    Pretoria, Gauteng, South Africa Qetello Holdings Full time

    At Qetello Holdings, we're seeking a skilled Medical Consultant to spearhead our pre-authorization efforts. This pivotal role demands an individual with extensive experience in the medical funding industry and exceptional negotiation skills.SalaryA competitive salary of $80,000 - $110,000 per annum is offered, commensurate with experience.About the RoleThe...

  • Pre-authorisation Consultant

    7 months ago

    Pretoria, South Africa HRInsync Full time

    **Company** One of the largest private Medical Aid companies in SA. They have been established for 20 years and are striving to be #1 in SA. **Purpose** Delivering cost-effective managed healthcare services to accomplish member satisfaction. **Responsibilities**: - Client Relations, To assist the client by approving appropriate funding - To deliver an...

  • Junior Pre-Auth Consultant: HBM

    3 months ago

    Pretoria, South Africa Qetello Holdings Full time

    Our client is looking for a Junior Pre-Auth Consultant (HBM) to deliver cost-effective managed healthcare services primarily via email correspondence, ensuring member satisfaction. The ideal candidate will have a Grade 12 qualification, Auxiliary Nursing certification, active SANC membership, a minimum of 5 years' experience as a nursing practitioner, and at...

  • Junior Pre-Auth Consultant: HBM

    3 months ago

    Pretoria, South Africa Qetello Holdings Full time

    Our client is looking for a Junior Pre-Auth Consultant (HBM) to deliver cost-effective managed healthcare services primarily via email correspondence, ensuring member satisfaction. The ideal candidate will have a Grade 12 qualification, Auxiliary Nursing certification, active SANC membership, a minimum of 5 years' experience as a nursing practitioner, and at...

  • Junior Pre-Auth Consultant: HBM

    3 months ago

    Pretoria, South Africa Qetello Holdings Full time

    Our client is looking for a Junior Pre-Auth Consultant (HBM) to deliver cost-effective managed healthcare services primarily via email correspondence, ensuring member satisfaction. The ideal candidate will have a Grade 12 qualification, Auxiliary Nursing certification, active SANC membership, a minimum of 5 years' experience as a nursing practitioner, and at...