Clinical Authorization Specialist

15 hours ago


Cape Town, Western Cape, South Africa Palesa Mbali Group Full time
Job Summary

We are seeking a skilled Clinical Authorization Specialist to join our team at the Palesa Mbali Group. This is an exciting opportunity for a qualified professional to utilize their expertise in clinical authorization and customer service to make a meaningful impact.

About the Role

The Clinical Authorization Specialist will be responsible for authorizing hospital authorization requests, ensuring that requirements of clinical appropriateness, medical necessity, and clinical risk management are met. Key activities include:

  • Applying coding principles, medical scheme rules, and benefits to authorize hospital authorization requests;
  • Capturing accurate pre-authorisation data on the system;
  • Educating and assisting members by providing relevant clinical information to access correct clinical benefits;
  • Consulting member's healthcare professionals to make informed clinical decisions and manage financial risk;
  • Correctly escalating complex clinical calls;
  • Providing excellent customer service;
  • Addressing all customer complaints in alignment with policies and procedures to achieve stakeholder buy-in.
Requirements

To be successful in this role, you will need to have a formal nursing qualification (SANC enrolled nurse) and at least 2-3 years' experience in a general medical or general surgical ward, with at least 1 year at a private institution. You must also be computer literate and have a minimum of 3 years in the clinical space. Call centre experience and previous managed healthcare experience in a call centre environment are advantageous.

What We Offer

In return for your expertise and dedication, we offer a competitive salary of R450,000 per annum, commensurate with your experience, as well as opportunities for growth and development within the company.

Palesa Mbali Group is a highly respected organization with many top medical schemes under its umbrella. Our team is passionate about delivering exceptional customer service and making a positive impact on people's lives.



  • Cape Town, Western Cape, South Africa Palesa Mbali Group Full time

    As a Clinical Authorization Specialist at Palesa Mbali Group, you will play a crucial role in ensuring that hospital authorization requests are processed efficiently and effectively. Your primary responsibility will be to review and authorize requests, ensuring that they meet the necessary clinical criteria, medical necessity, and risk management...

  • Clinical Authorizer

    4 weeks ago


    Cape Town, Western Cape, South Africa Palesa Mbali Group Full time

    Palesa Mbali Group is seeking a skilled Clinical Authorizer to join our Pre-Authorization Call Centre team.The successful candidate will be responsible for authorizing hospital authorization requests, ensuring compliance with clinical appropriateness, medical necessity, and risk management principles.Key Responsibilities:Apply coding principles, medical...


  • Cape Town, Western Cape, South Africa Palesa Mbali Group Full time

    Job SummaryThe Palesa Mbali Group seeks a Medical Authorization Specialist to join their team in the pre-authorization call centre. This role involves authorizing hospital authorization requests, ensuring that requirements of clinical appropriateness, medical necessity and clinical risk management are met.Main ResponsibilitiesApply coding principles, medical...


  • Cape Town, Western Cape, South Africa Palesa Mbali Group Full time

    Job Title: Prospective ReviewerAbout the RoleThe Prospective Reviewer will be responsible for authorizing hospital authorization requests, ensuring compliance with clinical appropriateness, medical necessity, and clinical risk management requirements.Key ResponsibilitiesAuthorize hospital authorization requests by applying coding principles, medical scheme...


  • Cape Town, Western Cape, South Africa Shoprite Full time

    Job SummaryWe are seeking a highly skilled SAP Authorization Specialist to join our team at Shoprite. The successful candidate will be responsible for designing, building, testing, and maintaining authorization roles to meet business requirements.Key ResponsibilitiesDesign and implement authorization roles to meet business requirementsTest and transport...


  • Cape Town, Western Cape, South Africa Emporium Human Capital Full time

    Job Title: Clinical Facilitation SpecialistAbout the Role:Emporium Human Capital is seeking a skilled Clinical Facilitation Specialist to join our team. As a Clinical Facilitation Specialist, you will be responsible for facilitating clinical training and education for nurses in a critical care setting.Key Responsibilities:Facilitate clinical training and...


  • Cape Town, Western Cape, South Africa Isilumko Staffing Full time

    Job DescriptionWe are seeking an experienced SAP Authorization Specialist to join our team at Isilumko Staffing.The ideal candidate will have a strong background in SAP authorization and governance, with at least 4 years of experience in similar roles.Key Responsibilities:Understanding of business processes and IT service operationsConfiguration management...

  • Clinical Specialist

    6 days ago


    Cape Town, Western Cape, South Africa Mediclinic Cape Town Full time

    About UsMediclinic Southern Africa is a leading private healthcare brand in South Africa and Namibia, offering exciting opportunities for specialists to establish their own private practices at our facilities and hospitals.Compensation PackageWe are committed to providing competitive compensation packages to attract and retain top talent. The estimated...


  • Cape Town, Western Cape, South Africa IQVIA Full time

    Job OverviewWe are seeking a seasoned Clinical Operations Leader to oversee the delivery of site activation, maintenance, and regulatory activities for our clients. In this role, you will be responsible for directing and managing the execution of pre-award activities, scope of work, budget, and resources.Key Responsibilities:Develop and implement management...


  • Cape Town, Western Cape, South Africa Dymaxa Recruitment Full time

    Job Title: Clinical Care SpecialistJob Description:We are seeking an experienced Clinical Care Specialist to join our team at Dymaxa Recruitment. The successful candidate will be responsible for providing high-quality nursing care to our clients in the Helderberg area.Responsibilities:Providing individualized care to residents, including health assessments...


  • Cape Town, Western Cape, South Africa Jordan HR Full time

    Job SummaryWe are seeking an experienced and skilled Senior Clinical Specialist to join our team at Jordan HR. This is a critical role that requires a strong clinical background, excellent communication skills, and the ability to lead and mentor staff.Key ResponsibilitiesCompany Overview: As a Senior Clinical Specialist, you will be responsible for providing...


  • Cape Town, Western Cape, South Africa Emporium Human Capital Full time

    Emporium Human Capital is seeking a skilled Clinical Facilitation Specialist to join our team in Gatesville. The ideal candidate will have a relevant Diploma/Degree in Nursing and registration with SANC as a professional nurse.Key responsibilities include:Developing and implementing clinical facilitation programs for nurses.Providing training and support to...


  • Cape Town, Western Cape, South Africa Zimmer Biomet Full time

    Job Title: Clinical Sales SpecialistAt Zimmer Biomet, we are committed to providing mobility and renewed life to people around the world. As a Clinical Sales Specialist, you will play a vital role in supporting our talented team in delivering exceptional customer experiences.Key Responsibilities:Collaborate with Sales Representatives, Key Account Managers,...


  • Cape Town, Western Cape, South Africa MMS Holdings Inc. Full time

    As a Clinical Safety Specialist at MMS Holdings Inc., you will be part of a supportive, innovative team that prides itself on being a Great Place to Work certified organization. We support the pharmaceutical, biotech, and medical device industries with our proven, scientific approach to complex trial data and regulatory submission challenges.Key...


  • Cape Town, Western Cape, South Africa Isilumko Staffing Full time

    Isilumko Staffing is seeking a skilled SAP Authorization Consultant to join our team in Cape Town. The ideal candidate will have 4 years of experience in Authorizations/GRC and a strong understanding of business process understanding, IT service operations, and IT configuration management.The successful candidate will have expertise in SAP ERP systems, SAP...


  • Cape Town, Western Cape, South Africa Shoprite Full time

    Job SummarySAP Authorization Administrator II is responsible for designing, building, testing, and maintaining authorization roles to meet business requirements. The ideal candidate will have a strong understanding of SAP Access Control principles and processes.Key ResponsibilitiesDesign and ImplementationDesign authorization roles to meet business...


  • Cape Town, Western Cape, South Africa Premium Consulting Full time

    Job Title: Clinical Support SpecialistJob Summary:At Premium Consulting, we seek a skilled Clinical Support Specialist to join our team. As a key member of our medical practice, you will provide exceptional administrative support and ensure the smooth operation of our reception area.Responsibilities:Provide exceptional patient service and support to...


  • Cape Town, Western Cape, South Africa RPO Recruitment Full time

    RPO Recruitment is seeking a dedicated Clinical Care Specialist to join their team at a reputable healthcare facility in Tokai. As a Clinical Care Specialist, you will play a crucial role in delivering high-quality patient care and assisting with the smooth operation of hospital wards.Key Responsibilities:Provide direct patient care under the supervision of...


  • Cape Town, Western Cape, South Africa National Renal Care Pty Full time

    About National Renal Care PtyNational Renal Care Pty is a leading healthcare provider in South Africa, offering comprehensive renal care services.Salary Range:R650,000 - R850,000 per annumJob Title: Clinical Specialist Dialysis NurseJob Description:The successful candidate will be responsible for performing dialysis according to prescription in a safe manner...


  • Cape Town, Western Cape, South Africa Isilumko Staffing Full time

    Isilumko Staffing is seeking a skilled SAP Authorization Consultant to join our team in Cape Town. The ideal candidate will have 4 years of experience in Authorizations/GRC and a solid understanding of business process understanding, IT service operations, and IT configuration management.Key Responsibilities:Manage IT configuration and ensure compliance with...