Pre Auth Case Manager - Sandton Verfied

R 300 000- 320 000 per annum Sandton, Gauteng Sandton, Gauteng more than 14 days ago 12-09-2016 1:57:20 PM
10-10-2016 1:57:20 PM
My client is looking for a Pre-Authorisation Case Manager for their Medical and Surgical Risk Management Department

Minimum Requirements:

Education, Qualifications and Experience:• Matriculation
• Nursing Qualification (Nursing Diploma as a registered nurse or enrolled nurse)
• Previous pre-authorisation experience in a managed healthcare environment would be an
advantage


• Fluency in another language would be an advantage
• Computer literacy essential – windows packages especially Microsoft Word and Excel
• Excellent telephonic communication skills
• Logical thinker
• Excellent report writing skills
• Able to apply clinical knowledge
• Good organisational skills
• Good time management skills
• Able to problem solve
• Excellent knowledge of ICD 10 codes, CPT 4 codes and Prescribed Minimum Benefits

Duties:
• Liaise with the Medical Advisor
• Pre-authorise members admissions to hospital according to departmental protocols and guidelines
• Capture the authorisation on the Imed system
• Handle hospital updates telephonically and via e-mail
• Telephonic case management (monitoring of ongoing cases) and referral of cases for intensive case
management
• Final updates with hospitals and discount negotiations
• Handle member queries re hospitalisation and benefits
• Handle written communication including reports of motivation and correspondence
• Manage cost containment of hospital incidents
• Schedule the weekly roster for the call centre
• Ensure maintenance of the Call Centre’s SLA’s
• Liaise with the hospital/doctor/member/family
• Work with other healthcare personnel within the organisation
• Provide clinical expertise within the organisation where required
• Ensure good communication between various departments
• Hours of work – rotation as per the pre-authorisation call centre roster