Pretoria: Medical Pre-Authorisation Consultant (Enrolled Nurse) posted by Qetello
Posted on 2025-04-29 00:00:00
| Employer | Qetello |
|---|---|
| Category | Medical Professions |
| Location | Gauteng / Pretoria |
Job Summary
Together with our client in Pretoria, we are recruiting for a Medical Pre-Authorisation Consultant. The ideal candidate must have a completed qualification as an Enrolled Nurse and must be registered with SANC, with at least 2 years experience in Managed Healthcare.
Duties and responsibilities:
- Receive applications for all services, which require pre-authorisation and attend to the request.
- Capture clinical information and verify the information, including the applicable ICD-10 and item codes.
- Validate and evaluate special pre-authorisation requests.
- Prepare a summary of the members clinical history for the medical advisor.
- Monitor the flow of documents between the pre-authorisation division and the medical advisor.
- Approve benefits accurately according to the benefits per benefit options and strictly according to protocols.
- Escalate identified risks about specific members or providers to seniors.
Skills and Qualifications:
- Grade 12
- Completed qualification as an Enrolled Nurse
- Registered with SANC
- 2+ years of experience in Managed Healthcare
- Good verbal and written English communication skills as well as proficiency in understanding Afrikaans spoken and written communication.
- Computer literate in Ms Office.
- Customer focus.
- Must be able to work in a team and handle conflict situations.
- Knowledge of the following:
- Comprehensive knowledge of the Medical Scheme Act;
- Sound knowledge of CPT-4, ICD-10 and RPL codes;
- Extensive clinical knowledge;
- Able to function independently with good decision-making skills; and
- Exceptional work ethic.
Only candidates who meet all the requirements outlined in this advertisement will be considered. If you do not receive feedback from us within 2 weeks of your application, please consider your application unsuccessful.
To apply, please submit your CV and supporting documents to *****@*****.co.za with the subject line REF: Pre-Auth.
Click Go Apply to apply online!
Get Similar Job Alerts
Apply directly for this position. Please read all instructions carefully.
We do not process job applications; we simply aggregate and display job listings.
More related positions
Pretoria North: Nursing Case Manager posted by Medstep Clinic
Responsibilities requirementsNursing diploma Registered Nurse 3-5 years of nursing experience prior pre-authorization experience in managed healthcare is...
View Job
Nursing Case Manager
Pretoria: HVAC OFFICE ADMINISTRATOR – Air-Conditioning posted by All Out Group PTY LTD
AIR-CONDITIONING ADMINISTRATOR REQUIREDAll Out Group is looking for a dynamic and energetic Admin person whom is currently in the HVAC Air-conditioning...
View Job
HVAC OFFICE ADMINISTRATOR – Air-Conditioning
Pretoria North: Grill Cook posted by Hen Houz Takeaway
Preparation and cooking of food.Assisting in all areas of the kitchen.Ensuring the kitchen areas are clean and tidy.Maintaining health and safety...
View Job
Grill Cook
Pretoria City: Call Center Agent posted by I-Com Services (Pty) Ltd
Call Center Agent for a Debt collection company based in Pretoria, Hatfield.800-1630, Monday-Friday
View Job
Call Center Agent
Pretoria East: Claims Specialist – Short Term posted by Career Crew
Job DescriptionWe are seeking a detail-oriented and experienced Claims Specialist to join our team. The successful candidate will be responsible for...
View Job
Claims Specialist – Short Term
Pretoria East: Commercial Underwriter – Transport industry posted by Career Crew
? Were Hiring Wanted! URGENT!Our Client is Pretoria East is looking to hire and experienced Commercial Underwriter Transport!With a keen eye for risk...
View Job
Commercial Underwriter – Transport industry
Pretoria City: Safety Officer/Manager posted by Malo Group
Position OverviewWe are seeking a dedicated and experienced Safety OfficerManager to join our team. The successful candidate will be responsible for...
View Job
Safety Officer/Manager
Pretoria: Financial Accountant (JB5105) posted by Kontak Recruitment
Financial Accountant JB5105Pretoria, Gauteng, South Africa Salary R28 - 35 000 per month A rapidly growing financial services provider is looking for a...
View Job
Financial Accountant (JB5105)
Pretoria: Aftersales and Repairs Manager posted by PRBB Solutions Pty Ltd
We are seeking a dedicated and detail-oriented Aftersales and Repairs Manager to join our team in Pretoria East. The ideal candidate will have experience in...
View Job
Aftersales and Repairs Manager
Pretoria: Candidate Attorney – With right of appearance posted by Cora O’Neil Recruitment Agency
Nieuw Muckleneuk, Pretoria CANDIDATE ATTORNEY Minimum Requirements-Presentable and professional preferably male -Good English proficiency speak, read and...
View Job
Candidate Attorney – With right of appearance
Pretoria: Litigation Secretary posted by Cora O’Neil Recruitment Agency
Brooklyn, Pretoria LITIGATION SECRETARYMinimum Requirements-Presentable and professional preferably female-Afrikaans and English first and second languages...
View Job
Litigation Secretary
Pretoria: Legal Collections Secretary posted by Cora O’Neil Recruitment Agency
Lynnwood, Pretoria LEGAL COLLECTIONS SECRETARY Minimum Requirements-Well presentable and professional Afrikaans speaking preferably female-Afrikaans ...
View Job
Legal Collections Secretary
Pretoria City: Office Administrator/Clerk posted by Hoogenhout Eiendomme
We are seeking an experienced Office AdministratorClerk to join our team. This role is ideal for a proactive, hardworking individual with a solid background...
View Job
Office Administrator/Clerk
Pretoria City: Close Protection Officer posted by MAFOKO SECURITY PATROLS
Valid PSIRA Grade AMatric CertificateClose Protection CertificateSA ID2 Years experience and more.
View Job
Close Protection Officer
Pretoria: Field Sales Rep – Advertising posted by Rekord
Were Hiring Sales Representative Are you passionate about sales and building client relationships? Join our growing team and make an impact in a rewarding...
View Job
Field Sales Rep – Advertising
Pretoria East: Maintenance Manager posted by Private
We require the services of a maintenance manager with strong managerial qualities for our group of companies. The ideal candidate will have knowledge of a...
View Job
Maintenance Manager
Pretoria: Corporate Project Account Manager (JB5118) posted by Kontak Recruitment
Corporate Project Account Manager JB5118Location Pretoria, South Africa Salary R45K - R60K Type Permanent Workplace In-OfficeA growing company seeks a...
View Job
Corporate Project Account Manager (JB5118)
Pretoria City: Junior Marketing Specialist (JB5117) posted by Kontak Recruitment
Junior Marketing Specialist JB5117Location Pretoria, South Africa Salary R20K - R25K Type Permanent Workplace In-OfficeA growing financial services...
View Job
Junior Marketing Specialist (JB5117)
Pretoria East: Deceased Estate Attorney – Urgent posted by Scateck CC
Looking for a Deceased Estate AttorneyMinimum 5 years ExperiencePosition based in Pretoria LynwoodAvailable as soon as possibleSalary as per experience.
View Job
Deceased Estate Attorney – Urgent
Pretoria East: Foreclosure Secretary – Urgent posted by Scateck CC
Urgently looking for a Full Foreclosure Secretary with MIN of 5 years experience.Must be able to runhandle the full foreclosure processportfolio in its...
View Job
Foreclosure Secretary – Urgent
Pretoria: Industrial Sewing/Seamstress – Experienced posted by Big Country Manufacturing
We are seeking a skilled preferably Male Sewing Operator Seamstress to join our team, specializing in the production of high-quality safari tents made from...
View Job
Industrial Sewing/Seamstress – Experienced
Pretoria: Sales Reps & Projects Manager required in the Glass & Aluminium Industry – URGENT posted by Montana Recruitment
Sales Reps Projects Manager required in the Glass Aluminium Industry Pretoria Centurion.Candidates must be based around Johannesburg...
View Job
Sales Reps & Projects Manager required in the Glass & Aluminium Industry – URGENT
Pretoria: SAQCC SANS 1475 Technician posted by Target fire protection
SAQCC Technician SANS 1475 with SAQCC cardValid drivers licenseAvailable Immediately.
View Job
SAQCC SANS 1475 Technician
Pretoria: Mechanical HVAC Engineer posted by Construct Executive Search
Applicants must have the following requirementsMust have a Bachelor of Science Degree or Bachelor of Technology Degree or Bachelor of Engineering Degree in...
View Job
Mechanical HVAC Engineer
Pretoria: Mechatronic Technician (Building Services) posted by Construct Executive Search
Applicants must have the following requirementsMust have a National Diploma in MechatronicsMust have Red Seal Certificate.Must have 1 - 3 years post...
View Job
Mechatronic Technician (Building Services)