Pre Authorisation Consultant
Registered Nurses with medical aid, managed healthcare experience
Established company in managed healthcare is looking for a Qualified Nurse that is experienced in Pre Authorisation to join their dynamic and growing team.


Job Details:

This role will provide pre-authorisation for hospitalisation, specialist visits, out of network visit, MRI and CT scans, step down facilities and home nursing.
Requesting clinical proof for new members and or dependants before pre-authorizations are given.
Accomplishing member satisfaction by delivering outstanding client services
Maintain good relations with clients and providers
Minimum Requirements:

Grade 12
Computer skills and knowledge of MS Word, MS Excel,MS Office, Outlook and InterNET
Afrikaans and English language skills
Enrolled Nurse
BCur Degree/ Diploma in Nursing
Minimum 2 - 3 years experience within such a role within a managed healthcare or medical aid environment
Knowledge required:

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

Permanent position

Corporate working hours

26 000.00 cost to company per month (ONLY negotiable depending on experience and qualification)

Medical aid and provident fund

Yearly performance based bonus

ONLY applicants that has ALL the above requirements will be considered for these positions.