Clinical Authorisation Specialist
2 months ago
The Prospective Reviewer role within the pre-authorisation call centre is a critical position that ensures the efficient processing of hospital authorisation requests. This role requires a strong understanding of clinical appropriateness, medical necessity, and clinical risk management principles.
Key Responsibilities:- Authorise hospital authorisation requests by applying coding principles, medical scheme rules, and benefits, as well as managed care policies and processes.
- Capture accurate pre-authorisation data on the system, ensuring that all relevant information is recorded.
- Educate and assist members by providing relevant clinical information to access the correct clinical benefits.
- Consult members' healthcare professionals to make informed clinical decisions and manage financial risk.
- Correctly escalate complex clinical calls, ensuring that all necessary steps are taken to resolve the issue.
- Provide excellent customer service, addressing all customer complaints in alignment with policies and procedures.
- Formal nursing qualification (SANC enrolled nurse) is required.
- 2-3 years' experience in a general medical or general surgical ward, with at least 1 year at a private institution.
- Trauma/ER experience will be an advantage.
- Previous managed healthcare experience in a call centre environment is advantageous.
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Clinical Authorisation Specialist
2 weeks ago
Johannesburg, Gauteng, South Africa Palesa Mbali Group Full time**Job Title:** Clinical Authorisation SpecialistWe are seeking a skilled Clinical Authorisation Specialist to join our team at Palesa Mbali Group. In this role, you will be responsible for authorising hospital authorisation requests to ensure that requirements of clinical appropriateness, medical necessity, and clinical risk management are met.Main...
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Clinical Authorisation Specialist
4 weeks ago
Johannesburg, Gauteng, South Africa Edge Executives Full timeJob Title: Pre-Authorisation ConsultantEdge Executives is seeking a highly skilled Pre-Authorisation Consultant to join our team. As a key member of our clinical governance team, you will be responsible for ensuring that hospital admissions and procedures are appropriately authorised and managed.Key Responsibilities:Pre-Authorisation of Hospital Admissions...
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Clinical Authorisation Specialist
1 month ago
Johannesburg, Gauteng, South Africa Edge Executives Full timeJob Title: Pre-Authorisation ConsultantEdge Executives is seeking a highly skilled Pre-Authorisation Consultant to join our team. As a key member of our healthcare team, you will be responsible for evaluating and approving pre-authorisation requests for hospital admissions, surgeries, and specialised medical treatments.Key Responsibilities:Pre-Authorisation...
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Clinical Authorisation Specialist
1 month ago
Johannesburg, Gauteng, South Africa Palesa Mbali Group Full timeJob Title: Prospective ReviewerThe Prospective Reviewer role within the pre-authorisation call centre is a critical position that requires a high level of clinical expertise and analytical skills. As a Prospective Reviewer, you will be responsible for ensuring that hospital authorisation requests meet the requirements of clinical appropriateness, medical...
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Clinical Authorisation Specialist
4 weeks ago
Johannesburg, Gauteng, South Africa Palesa Mbali Group Full timeJob Title: Prospective ReviewerThe Palesa Mbali Group is seeking a skilled and detail-oriented Prospective Reviewer to join our team in the pre-authorisation call centre. As a key member of our team, you will be responsible for ensuring that hospital authorisation requests meet the requirements of clinical appropriateness, medical necessity, and clinical...
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Healthcare Authorisation Specialist
5 days ago
Johannesburg, Gauteng, South Africa Palesa Mbali Group Full timeJob Title: Healthcare Authorisation SpecialistThe Palesa Mbali Group is seeking a skilled Healthcare Authorisation Specialist to join our pre-authorisation call centre team. As a Healthcare Authorisation Specialist, you will be responsible for authorising hospital authorisation requests, ensuring that requirements of clinical appropriateness, medical...
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Nursing Authorisation Specialist
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Johannesburg, Gauteng, South Africa Palesa Mbali Group Full timeThe Nursing Authorisation Specialist role within the pre-authorisation call centre at Palesa Mbali Group is responsible for ensuring that hospital authorisation requests meet the requirements of clinical appropriateness, medical necessity, and clinical risk management.Key Responsibilities:Authorise hospital authorisation requests by applying coding...
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Clinical Case Manager
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Clinical Management Specialist
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Clinical Data Specialist
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Clinical Training Coordinator
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Clinical Facilitator Specialist
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Clinical Support Specialist
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