Clinical Consultant Pre-authorisations Pretoria
Clinical Consultant Pre-authorisations Pretoria
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Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
Introduction
- Current SANC Registration is essential
- Registered or Enrolled Nurse (Diploma/ Degree)
- Solid clinical expertise in preauthorising hospital admissions including length of stay level of care inroom procedures and other healthcare services requiring prior approval
- Strong understanding of the South African healthcare sector industry regulations and medical coding structures (ICD10 CPT4 NRPL PMB conditions and clinical protocols) Testing on procedure codes will be conducted
- Commitment to maintaining confidentiality
- Resultsdriven approach
- Ability to compile and submit reports within strict deadlines
- High level of accuracy and attention to detail
- Strong analytical and research skills
- Fluent in English (written and spoken); an additional language would be advantageous
- Multitasking proficiency
- Excellent organisational and prioritisation abilities
- Selfdriven and capable of working independently
- Capacity to manage highpressure situations with professionalism and empathy
- Strong customer service orientation with the ability to engage effectively with external stakeholders including healthcare providers and scheme members
- Proficient in computer systems (assessment will be conducted); experience with MIP and/or MedCaps applications is beneficial
- Exceptional verbal and written communication skills particularly in a call centre environment (assessment will be conducted)
- 23 years of Preauthorisation experience within a managed healthcare or medical scheme setting
- Educate members on healthcare processes and guide those with chronic conditions into active disease management programs
- Present complex cases to case management for further assessment and resolution
- Respond to general inquiries related to benefits and authorisations
- Identify any comorbid conditions and escalate cases to case management for further intervention if necessary
- Perform clinical risk assessments to mitigate risks associated with hospital admissions and other preauthorised healthcare services
- Ensure strict compliance with scheme benefits rules and clinical guidelines for all service authorisations
- Process authorisations and apply standard protocols within a telephonic interaction
- Verify benefit eligibility according to scheme rules clinical protocols and funding guidelines
- Handle inbound calls from healthcare providers and medical scheme members regarding preauthorisations
- Copy of Comprehensive CV detailing PreAuth experience
- Copy of SANC Registration
- Copy of Nursing Diploma
- Copy of Matric Certificate
Required Experience:
Contract
Employment Type
Full-Time
