Clinical Authorization Specialist
2 months ago
We are seeking a skilled Clinical Authorization Specialist to join our Pre-Authorization Call Centre team. As a key member of our team, you will be responsible for authorizing hospital authorization requests, ensuring that requirements of clinical appropriateness, medical necessity, and clinical risk management are met.
Key Responsibilities- Apply coding principles, medical scheme rules, and benefits to authorize hospital authorization requests.
- Capture accurate pre-authorisation data on our system.
- 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.
- Provide excellent customer service and address customer complaints in alignment with policies and procedures.
- Formal nursing qualification (SANC enrolled nurse) – required.
- 2 – 3 years' experience in a general medical or general surgical ward, with at least 1 year at a private institution.
- Minimum of 3 years in the clinical space required.
- Must be computer literate.
- Call centre experience advantageous.
- Previous Managed Healthcare experience in a call centre environment – advantageous.
A highly respected company with many of the top medical schemes under our umbrella, we offer a dynamic and challenging work environment that fosters growth and development.
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Clinical Authorization Specialist
4 weeks ago
Cape Town, Western Cape, South Africa Palesa Mbali Group Full timeAs 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...
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Clinical Authorizer
2 weeks ago
Cape Town, Western Cape, South Africa Palesa Mbali Group Full timePalesa 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...
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Clinical Authorization Specialist
2 months ago
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Clinical Authorization Specialist
4 weeks ago
Cape Town, Western Cape, South Africa Palesa Mbali Group Full timeJob Title: Prospective ReviewerAt Palesa Mbali Group, we are seeking a highly skilled and experienced Prospective Reviewer to join our Pre-Authorization Call Centre team.Key Responsibilities:Authorize hospital authorization requests by applying coding principles, medical scheme rules, and benefits, and managed care policies and processes.Capture accurate...
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Medical Authorization Specialist
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Cape Town, Western Cape, South Africa Palesa Mbali Group Full timeJob 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...
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SAP Authorization Specialist
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Cape Town, Western Cape, South Africa Shoprite Full timeJob 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...
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SAP Authorization Specialist
2 months ago
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