Clinical Authorisation Specialist

2 months ago


Johannesburg, Gauteng, South Africa Palesa Mbali Group Full time
Job Title: Prospective Reviewer

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.
Requirements:
  • 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.


  • 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...


  • Johannesburg, Gauteng, South Africa Edge Executives Full time

    Job 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...


  • Johannesburg, Gauteng, South Africa Edge Executives Full time

    Job 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...


  • Johannesburg, Gauteng, South Africa Palesa Mbali Group Full time

    Job 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...


  • Johannesburg, Gauteng, South Africa Palesa Mbali Group Full time

    Job 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...


  • Johannesburg, Gauteng, South Africa Palesa Mbali Group Full time

    Job 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...


  • Johannesburg, Gauteng, South Africa Palesa Mbali Group Full time

    The 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...

  • Clinical Case Manager

    4 weeks ago


    Johannesburg, Gauteng, South Africa Edge Executives Full time

    Job SummaryWe are seeking a highly skilled Clinical Case Manager to join our team at Edge Executives. As a key member of our healthcare operations team, you will be responsible for managing hospital admissions, conducting clinical assessments, and coordinating with healthcare providers to ensure the most efficient and cost-effective care is delivered to...

  • Clinical Case Manager

    3 weeks ago


    Johannesburg, Gauteng, South Africa Edge Executives Full time

    Job SummaryEdge Executives is seeking a highly skilled Clinical Case Manager to join our team. As a key member of our healthcare team, you will be responsible for managing hospital admissions, conducting clinical assessments, and coordinating with healthcare providers to ensure the most efficient and cost-effective care is delivered to patients.Key...


  • Johannesburg, Gauteng, South Africa Energy at Work Projects Full time

    Role OverviewEnergize your career with Energy at Work Projects as a key player in the Motor Industry. We're seeking a skilled Technical Authorisations Agent to drive innovation and excellence in our team.ResponsibilitiesEvaluate and authorise technical proposals to ensure compliance with industry standards and company policiesDelve into technical...


  • Johannesburg, Gauteng, South Africa Edge Executive Search Full time

    Edge Executive Search is seeking a dedicated and experienced Clinical Management Specialist to join their team and manage the spending of member funds through clinical interventions and the application of managed care protocols.Key Responsibilities:To provide clinical leadership and oversight to ensure high-quality patient care.To develop and implement...


  • Johannesburg, Gauteng, South Africa Kaelo Full time

    Clinical Support SpecialistThe Clinical Support Specialist is a key role within Kaelo Lifestyle, responsible for providing high-quality telephonic counselling services to clients. This specialist will establish suitable treatment plans, execute these plans through quality telephonic counselling, and manage longer-term cases referred by the inbound EAP...


  • Johannesburg, Gauteng, South Africa HR Genie Full time

    We are seeking a visionary Clinical Leadership Specialist to lead our client's organization.Develop and implement the organization's overall strategy and goals.Provide leadership and guidance to ensure alignment with the company's mission and objectives.Foster a culture of innovation, accountability, and operational excellence.Lead regional clinical research...


  • Johannesburg, Gauteng, South Africa Allmed Healthcare Professionals Full time

    {"title": "Clinical Care Specialist", "content": "Job SummaryWe are seeking a dedicated Clinical Care Specialist to join our Frail Care team in Johannesburg.Location: Sandringham, JohannesburgJob Type: Temp / Agency Shifts (following a 5 day orientation at the facility)Key ResponsibilitiesAccurately document nursing care based on resident observations and...


  • Johannesburg, Gauteng, South Africa Anova Health Institute NPC Full time

    Job SummaryAnova Health Institute NPC is seeking a highly skilled Infectious Disease Specialist to provide clinical care and training to our team.Key ResponsibilitiesProvide clinical care for in-patients with Advanced HIV Disease, complicated TB or other infectious diseases referred to you by Anova & Department of Health clinicians from public clinics and...


  • Johannesburg, Gauteng, South Africa AJ Personnel Full time

    About the RoleWe are seeking a highly skilled Clinical Data Specialist to join our team at AJ Personnel. As a key member of our team, you will be responsible for collecting and accurately reporting clinical data for surveillance and research purposes from patients at designated sites.ResponsibilitiesLiaise closely with provincial, district, and facility...


  • Johannesburg, Gauteng, South Africa Wits University Full time

    Job Title: Clinical Training CoordinatorWits University is seeking a highly skilled and experienced Clinical Training Coordinator to join our team. The successful candidate will be responsible for coordinating the clinical training of medical students in the final two years of the MBBCh degree, including the general management of clinical rotations and...


  • Johannesburg, Gauteng, South Africa TalentCru Full time

    Job Title: Clinical FacilitatorTalentCru is seeking a highly skilled Clinical Facilitator to join our team in Gauteng. As a Clinical Facilitator, you will play a crucial role in maintaining and growing our database of potential candidates, ensuring the quality and ongoing performance of our assignees, and managing their performance management at the clinical...


  • Johannesburg, Gauteng, South Africa Kaelo Full time

    Clinical Consultant Job DescriptionThe Clinical Consultant is a highly skilled professional responsible for delivering clinical support and counselling services to clients. This role requires a deep understanding of clinical practices and the ability to establish effective treatment plans.Key Responsibilities:Provide high-quality telephonic counselling...


  • Johannesburg, Gauteng, South Africa Kaelo Full time

    {"title": "Clinical Consultant", "description": "Job SummaryKaelo Lifestyle is seeking a highly skilled Clinical Consultant to join our team. As a Clinical Consultant, you will be responsible for managing clinical support and providing counselling services to our clients.Key ResponsibilitiesEstablish and execute clinically sound treatment plans for...