Pre-authorisation Consultant
2 weeks ago
**Pre-Authorisation Consultant**
**Introduction**
One of the largest private Medical Aid companies in SA. They have been providing healthcare to the lives of South Africans for over 56 years. And are striving to be #1 in SA.
**Purpose**
Delivering cost-effective managed healthcare services to accomplish member satisfaction.
**Duties & Responsibilities**
- Client Relations, to assist the client by approving appropriate funding
- Effective Customer Service delivery, to deliver an effective call centre service in order to achieve member satisfaction
- Telephone Etiquette, answering telephone calls in a way that achieves member satisfaction
- Verifying prosthesis limits, to contain costs for both members and fund
- On-going training and development, to update knowledge and skills in order to deliver a cost-effective and professional service
- The actual benefit expenditure per beneficiary per month for hospitalization should be less than the budget benefit expenditure
- Pre-authorization should be granted within the option benefits, Scheme and clinical protocols
- Delivering a cost-effective Managed Healthcare service within the average length of hospital stay per beneficiary
- Thorough, well-grounded clinical knowledge of Pre-Authorization of hospital admissions and Case Management of hospital cases in order to take cost-effective and appropriate decisions in evaluating treatment, LOS and LOC
- Knowledge of the current coding structures in the South African Health Care environment i.e. ICD10’s, CPT4, NRPL, and PMB conditions, protocols and Scheme rules
**Skills & Qualifications**
Qualification - Essential
- Grade 12
- Enrolled Nurse
Qualification - Preferred
- B Cur degree / Diploma in Nursing
- Registered Nurse
Experience - Essential
- Minimum 5 years’ experience as a nursing practitioner
- Minimum 1-year experience gained in the medical funding industry
**Job Types**: Full-time, Permanent
**Salary**: R30,000.00 - R34,000.00 per month
Ability to commute/relocate:
- Pretoria, Gauteng: Reliably commute or planning to relocate before starting work (required)
**Education**:
- Diploma (required)
**Experience**:
- nursing practitioner: 5 years (required)
- medical funding industry: 1 year (required)
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Pretoria, South Africa Medical Resources Group (Pty) Ltd Full timeOur client is looking for a Pre-Auth Consultant (Enrolled Nurse) to deliver cost-effective managed healthcare services primarily via email correspondence, ensuring member satisfaction. The ideal candidate will have a Grade 12 qualification, Auxiliary Nursing certification, active SANC membership, a minimum of 5 years' experience as a nursing practitioner,...
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Pretoria, South Africa Medical Resources Group (Pty) Ltd Full timeOur client is looking for a Pre-Auth Consultant (Enrolled Nurse) to deliver cost-effective managed healthcare services primarily via email correspondence, ensuring member satisfaction. The ideal candidate will have a Grade 12 qualification, Auxiliary Nursing certification, active SANC membership, a minimum of 5 years' experience as a nursing practitioner,...
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Pretoria, South Africa Medical Resources Group (Pty) Ltd Full timeOur client is looking for a Pre-Auth Consultant (Enrolled Nurse) to deliver cost-effective managed healthcare services primarily via email correspondence, ensuring member satisfaction. The ideal candidate will have a Grade 12 qualification, Auxiliary Nursing certification, active SANC membership, a minimum of 5 years' experience as a nursing practitioner,...
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Pretoria, Gauteng, South Africa Medical Resources Group (Pty) Ltd Full time R350 000 - R550 000 per yearOur client is looking for a Pre-Auth Consultant (Enrolled Nurse) to deliver cost-effective managed healthcare services primarily via email correspondence, ensuring member satisfaction. The ideal candidate will have a Grade 12 qualification, Auxiliary Nursing certification, active SANC membership, a minimum of 5 years' experience as a nursing practitioner,...
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Pretoria, South Africa Medical Resources Group (Pty) Ltd Full timeOur client is looking for a Pre-Auth Consultant (Enrolled Nurse) to deliver cost-effective managed healthcare services primarily via email correspondence, ensuring member satisfaction. The ideal candidate will have a Grade 12 qualification, Auxiliary Nursing certification, active SANC membership, a minimum of 5 years' experience as a nursing practitioner,...
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