Clinical Authorization Specialist
1 month ago
In this role, you will work as a Clinical Pre-Authorization Consultant at Qetello Holdings. As a key member of our team, you will be responsible for reviewing pre-authorisation applications and ensuring that they meet the required criteria.
Key Responsibilities- Application Review: Process and evaluate pre-authorisation applications to ensure accuracy and compliance with regulations.
- Telephonic Authorisations: Handle pre-authorisations for hospital and radiology services through telephonic interactions with patients and service providers.
- Data Entry & Verification: Accurately capture and verify clinical details, including ICD-10 and item codes, to support decision-making.
- Membership Validation: Confirm membership status and available benefits prior to granting authorisation to ensure seamless service delivery.
- Special Requests: Assess and process special pre-authorisation applications requiring additional analysis or expertise.
- Coding Accuracy: Apply appropriate coding before approving benefits to ensure accurate reimbursement.
- Clinical Interpretation: Analyse medical reports and doctors' motivations to inform decision-making.
- Information Sharing: Provide patients and service providers with clear, relevant information on scheme rules, benefits, and approvals.
- Benefits Management: Approve benefits in line with benefit options and protocols to mitigate scheme risks.
- Record Keeping: Maintain accurate records of all transactions and documentation to ensure transparency and accountability.
- Service Excellence: Deliver outstanding service to members and providers, focusing on exceptional customer experience.
- Continuous Learning: Stay updated on scheme rules, benefit options, legislation, protocols, and system changes to maintain expertise and adapt to evolving requirements.
- Education: Minimum Grade 12 certificate, with a degree or diploma in nursing.
- Nursing Qualification: Registration with the South African Nursing Council (SANC).
- Experience: At least two years of experience in a private hospital or managed healthcare setting.
R500,000 - R700,000 per annum, depending on qualifications and experience.
About UsQetello Holdings is a dynamic organisation dedicated to providing innovative solutions in the healthcare sector. We are committed to delivering exceptional service and fostering a culture of excellence among our team members.
-
Eyesight Specialist Clinical Assistant
2 days ago
Pretoria, Gauteng, South Africa MedE Recruit Full timeMedE Recruit: Exceptional Ophthalmic Care OpportunityAn exciting opportunity has become available for an Optometrist to work as an Ophthalmic Assistant at a prestigious Eye Clinic in Pretoria.This leading eye care facility provides top-notch ophthalmic services to its patients, and it seeks candidates who share the same values and standards to join its...
-
Clinical Care Specialists
4 weeks ago
Pretoria, Gauteng, South Africa Beaver Immigration Consulting Full timeAbout the JobWe are seeking a highly skilled Registered Nurse to join our team at Beaver Immigration Consulting. This is a great opportunity for a nurse who wants to make a difference in the lives of patients and their families.As a Registered Nurse, you will be responsible for providing high-quality patient care and working collaboratively with other...
-
Radiology Specialist
4 weeks ago
Pretoria, Gauteng, South Africa ES Recruitment Full timeJob Overview: As a Radiology Specialist, you will be responsible for developing and executing sales strategies to drive growth and achieve sales targets for radiology equipment, CAD AI software, mobile X-ray clinics, and related services. This role requires strong relationships with key decision-makers and stakeholders within the healthcare...
-
Eye Care Specialist Opportunity in Pretoria
3 weeks ago
Pretoria, Gauteng, South Africa MedE Recruit Full timeMedE Recruit Seeks Experienced Optometrist for Ophthalmic Assistant RoleWe are seeking a skilled and motivated Optometrist to join our team as an Ophthalmic Assistant at a reputable eye care facility in Pretoria. This is an exciting opportunity for a qualified professional to work closely with Eye Specialists, providing exceptional patient care and...
-
Medical Pre-Authorisation Specialist
3 weeks ago
Pretoria, Gauteng, South Africa Qetello Holdings Full timeJob 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...
-
EYE CARE SPECIALIST OPPORTUNITY IN PRETORIA
2 weeks ago
Pretoria, Gauteng, South Africa MedE Recruit Full timeOptometrist - Ophthalmic Assistant RoleMedE Recruit is proud to present an exciting opportunity for an Optometrist to join our team as an Ophthalmic Assistant at a renowned eye clinic in Pretoria.The ideal candidate will have a strong passion for delivering exceptional patient care and be eager to work closely with experienced Eye Specialists.About the...
-
Diagnostic Imaging Specialist
4 weeks ago
Pretoria, Gauteng, South Africa Beaver Immigration Consulting Full timeJob OverviewWe are seeking a highly skilled Diagnostic Imaging Specialist to join our team at Beaver Immigration Consulting. This role involves operating X-ray equipment to produce high-quality diagnostic images, positioning patients and equipment for optimal image capture, and collaborating with radiologists to discuss imaging results.Key...
-
Eye Specialist Medical Assistant
4 weeks ago
Pretoria, Gauteng, South Africa MedE Recruit Full timeMedE Recruit is seeking an experienced and highly skilled Eye Specialist Medical Assistant to join their esteemed team in Pretoria.This exciting opportunity offers a unique chance to work alongside leading eye care professionals, providing exceptional patient care and contributing to the success of the clinic.About the Role:Assist Eye Specialists in...
-
Computed Tomography Specialist
4 weeks ago
Pretoria, Gauteng, South Africa Beaver Immigration Consulting Full timeJob Overview:As a Computed Tomography Specialist at Beaver Immigration Consulting, you will play a critical role in producing accurate and timely diagnostic images using advanced CT scanning equipment. This position requires a strong background in Diagnostic Radiography and excellent communication skills to effectively interact with patients and healthcare...
-
Patient Financial Specialist
4 weeks ago
Pretoria, Gauteng, South Africa Oasis Healthservices Full timeJob Description:The successful candidate will be responsible for managing the financial and clinical risks of the patient in a general ward by ensuring accurate coding, clinical updates, and accounts submissions of patient hospitalization to achieve strategic objectives.Critical Outputs:Ensuring the maximisation of revenue by ensuring accurate coding,...
-
Reliable Healthcare Transportation Specialist
3 weeks ago
Pretoria, Gauteng, South Africa People Dimension Full timeAbout UsWe are People Dimension, a well-established medical supplier based in Irene. We are committed to providing high-quality medical supplies and exceptional customer service.The RoleThis is an exciting opportunity to join our logistics team as a Reliable Healthcare Transportation Specialist. You will be responsible for delivering medical supplies to...
-
Senior Software Engineering Specialist
1 day ago
Pretoria, Gauteng, South Africa Tumaini Consulting Full timeJob Title: Senior Software Engineering SpecialistOverview:Tumaini Consulting, a forward-thinking digital agency specializing in crafting innovative solutions for businesses, is seeking an experienced software engineering specialist to join the team.Salary: R500 000 - R700 000 per annumJob Description:The successful candidate will be responsible for...
-
Dental Hygiene Specialist
3 weeks ago
Pretoria, Gauteng, South Africa MedE Recruit Full timeDental Practice OverviewThe MedE Recruit is seeking a skilled Oral Hygienist to join their team in Montana. This role offers a unique mix of clinical, administrative, and marketing responsibilities.Job Description:The successful candidate will be responsible for overseeing the management of the practice's mobile clinic. Key duties include:Managing...
-
Dental Hygiene Specialist
4 weeks ago
Pretoria, Gauteng, South Africa MedE Recruit Full timeMedE Recruit is a reputable dental practice in Montana, Pretoria, seeking a motivated and versatile HPCSA Registered Oral Hygienist to join their team. This role offers a unique mix of clinical, administrative, and marketing responsibilities, allowing the successful candidate to grow beyond the typical oral hygiene duties.The ideal candidate will have strong...
-
ESG Sustainability Specialist
3 weeks ago
Pretoria, Gauteng, South Africa IT Ridge Technologies Full timeJob DescriptionThis role is responsible for implementing the Environmental, Social, and Governance (ESG) Strategic Framework across various business units. The ESG Specialist will work closely with the General Manager to bring on board ESG specialist capabilities and support the implementation of the Group's ESG Strategic Framework and applicable...
-
Ophthalmic Specialist Opportunity in Pretoria
2 months ago
Pretoria, Gauteng, South Africa MedE Recruit Full timeMedE Recruit is seeking a qualified Optometrist to fill the position of an Ophthalmic Assistant at our esteemed eye care facility in Pretoria. This role offers a unique opportunity for professionals to work closely with experienced Eye Specialists and contribute to providing exceptional patient care.Key Responsibilities:Collaborate with Eye Specialists in...
-
Pharmaceutical Quality Assurance Specialist
3 weeks ago
Pretoria, Gauteng, South Africa Isilumko Staffing (JHB) Full timeJob Title: Pharmaceutical Quality Assurance SpecialistLocation: Johannesburg, South AfricaAbout the Role:The successful candidate will be responsible for ensuring adherence to the quality management system (QMS) and current Good Manufacturing Practices (GMP), as well as ISO 9001. The role involves managing and controlling the process for the quarantine,...
-
Software Solutions Specialist
4 weeks ago
Pretoria, Gauteng, South Africa ES Recruitment Full timeResponsibilitiesDevelop and execute strategic sales plans to achieve sales targets and expand our customer base.Identify and engage potential clients in the company sector, including hospitals, clinics, public health programs, and private company providers.Promote our comprehensive software solutions, emphasizing the benefits of our company plans and...
-
Medical Software Solutions Specialist
3 weeks ago
Pretoria, Gauteng, South Africa ES Recruitment Full timeJob Title: Medical Software Solutions SpecialistAbout ES Recruitment:We offer a comprehensive range of innovative healthcare software solutions that are designed to improve healthcare delivery through technology and integrated platforms. Our cloud-based software solutions manage all aspects of patient care and healthcare program workflows.Job Description:We...
-
Strategic Learning and Development Specialist
1 month ago
Pretoria, Gauteng, South Africa HR Genie Full timeAt HR Genie, we're seeking a highly experienced Strategic Learning and Development Specialist to join our team.Job SummaryThis is an exciting opportunity for a skilled professional with a strong background in skills development and training to lead the design, implementation, and evaluation of learning programs that drive business results.About the RoleWe...