Clinical Authorization Specialist

1 week ago


Pretoria, Gauteng, South Africa Qetello Holdings Full time
Job Overview

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.
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.
Estimated Salary:

R500,000 - R700,000 per annum, depending on qualifications and experience.

About Us

Qetello 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.



  • Pretoria, Gauteng, South Africa Qetello Holdings Full time

    Job OverviewWe are seeking a highly skilled Clinical Authorization Specialist to join our team at Qetello Holdings in Pretoria. This is an exciting opportunity for a motivated individual to make a meaningful contribution to our organization.


  • Pretoria, Gauteng, South Africa Qetello Holdings Full time

    Role OverviewWe are seeking a highly skilled Medical Pre-Authorization Specialist to join our team at Qetello Holdings in Pretoria. This role is an excellent opportunity for a professional nurse looking to advance their career in managed healthcare.


  • Pretoria, Gauteng, South Africa H2R Africa Full time

    Job Title: Clinical Specialist for Spinal ManagementH2R Africa is seeking a dedicated Clinical Specialist for Spinal Management to join our team. The successful candidate will be responsible for managing the access, clinical appropriateness, and risk of services related to back and neck pain management, spinal surgery, and associated healthcare services.Key...


  • Pretoria, Gauteng, South Africa Discovery Limited Full time

    Job Title: Home Based Care Clinical Specialist At Discovery Limited, we are seeking a highly skilled and experienced Home Based Care Clinical Specialist to join our team.Job Description:As a Home Based Care Clinical Specialist, you will be responsible for providing high-quality care to patients in their own homes. You will work autonomously, performing...


  • Pretoria, Gauteng, South Africa South African Police Service Full time

    **Job Title: Support Specialist for Executive Authority Portfolio** We are seeking a highly skilled and experienced individual to provide administrative support to the office of the executive authority, focusing on matters related to their portfolio. About the Role:The successful candidate will be responsible for coordinating activities between our...


  • Pretoria, Gauteng, South Africa Finding Personnel (Pty) Ltd Full time

    Job Title: Clinical Aesthetics SpecialistIndustry: Medical PracticeLocation: Menlyn Maine, PretoriaSalary: R22,000 (dependent on experience, qualifications, and current earnings)Working Hours: 08:30 – 18:30 (every Monday and Saturday, with a weekday off)Travel Flexibility: National pop-up eventsAbout the RoleThe Clinical Aesthetics Specialist will deliver...


  • Pretoria, Gauteng, South Africa NGO Pulse Full time

    Job DescriptionNGO Pulse seeks a highly skilled Clinical Nurse Specialist to join our team in the public healthcare sector. The successful candidate will be responsible for providing clinical leadership and expertise in the management of TB and HIV programs.Key ResponsibilitiesProvide clinical leadership and guidance to healthcare professionals in the...


  • Pretoria, Gauteng, South Africa DG Murray Trust (DGMT) Full time

    We are seeking a skilled Project Manager to lead the implementation of our Mobile Health Clinics project. The successful candidate will oversee the procurement and delivery of mobile health clinics to four locations across South Africa.About the RoleThis is a full-time position that requires strong project management skills, experience in healthcare...


  • Pretoria, Gauteng, South Africa Mediclinic Vereeniging Full time

    Mediclinic Southern Africa is committed to delivering exceptional healthcare services to patients across South Africa and Namibia.We are seeking a dynamic and experienced Pulmonologist to join our team of medical experts, providing high-quality patient care and contributing to the growth and development of our medical facilities.Key Responsibilities:Deliver...


  • Pretoria, Gauteng, South Africa Dis-Chem Pharmacies Full time

    Job Title:Clinical Support Specialist - Gauteng RegionAbout the Role:We are seeking a highly skilled and experienced Clinical Support Specialist to join our team at Dis-Chem Pharmacies in the Gauteng region. As a key member of our clinical support team, you will be responsible for providing exceptional patient care and support in our pharmacies.Key...


  • Pretoria, Gauteng, South Africa MNA Recruitment (Pty) Ltd Full time

    MNA Recruitment (Pty) Ltd is seeking a highly skilled Clinical Start Up Trial Specialist to join our team in Southern Africa. The successful candidate will be responsible for driving and executing start-up and maintenance-related activities for assigned studies and sites in their designated region.The estimated annual salary for this role is R600,000 -...


  • 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...


  • Pretoria, Gauteng, South Africa MNA Recruitment (Pty) Ltd Full time

    Job SummaryThe Clinical Start-Up Trial Specialist will be responsible for driving and executing all start-up and maintenance-related activities and deliverables for assigned studies and sites in their assigned country or countries.Key ResponsibilitiesEnsure the successful, on-time, and quality execution of start-up and maintenance activities for assigned...


  • Pretoria, Gauteng, South Africa Human Accent Ltd Full time

    Job Title: Registered Dietitian NutritionistWe are seeking a highly skilled Registered Dietitian to join our product development team at Human Accent Ltd. The ideal candidate will apply their expertise in clinical nutrition to ensure that our products align with the highest health standards and support overall well-being.Key Responsibilities: Product...


  • Pretoria, Gauteng, South Africa hearX Group Full time

    We are seeking a highly skilled Clinical Administrator to join our team at hearX Group in Pretoria. This is an exciting opportunity for someone with experience in data management and administration to take on a challenging role that involves working closely with clinical research teams.Job DescriptionThis role will involve managing and maintaining accurate...


  • Pretoria, Gauteng, South Africa Kontak Recruitment Full time

    We are seeking a skilled Social Behaviour Research Specialist to join our client's Clinical Research team. This role focuses on integrating social behaviour research into clinical studies, evaluating behavioural patterns, societal influences, and community engagement in healthcare.Duties and Responsibilities:Integration of Social Behaviour Research: Design...


  • Pretoria, Gauteng, South Africa MNA Recruitment (Pty) Ltd Full time

    Job Title: Clinical Start Up Trial SpecialistAbout the Role:The Specialist, Country SSU proactively drives and executes all start-up and maintenance-related activities and deliverables for assigned studies and sites in their assigned country or countries.Key Responsibilities:1. Start-Up and Maintenance Activities* Ensure the successful, on-time, and quality...


  • Pretoria, Gauteng, South Africa MMS Holdings Inc. Full time

    MMS Holdings Inc. is a leading data-focused clinical research organization (CRO). We are seeking an experienced Medical Data Specialist - Oncology to join our team.As a Medical Data Specialist - Oncology, you will be responsible for reviewing and analyzing clinical trial data related to oncology products. This role requires strong knowledge of medical...


  • Pretoria, Gauteng, South Africa Qetello Holdings Full time

    Job Title: Medical Pre-Authorisation SpecialistWe are seeking a highly skilled Medical Pre-Authorisation Specialist to join our team at Qetello Holdings. As a key member of our team, you will be responsible for managing pre-authorisation requests and ensuring seamless communication between our medical advisors and clients.Key Responsibilities:Receive and...


  • Pretoria, Gauteng, South Africa National Renal Care Pty Full time

    Job Title: Renal Care SpecialistWe are seeking a skilled Renal Care Specialist to join our team at National Renal Care Pty in Pretoria, Gauteng.About the Role:To perform dialysis according to prescription in a safe manner and follow NRC's internal policies and procedures.To provide optimal patient care per the nursing scope of practice and NRC's clinical...