| Date | 2024-11-24 |
|---|---|
| Job Title | Prospective Reviewer (Preauthorisation Consultant) |
| Employer | Palesa Mbali Group More Information |
| Salary | 0 |
| Category | Medical |
| Location |
Western Cape / Cape Town |
Job Summary
Prospective Reviewer (Pre-Authorization Call Centre)
The Prospective Reviewer role within the pre-authorization call centre, is responsible for authorizing hospital authorization requests ensuring that requirements of clinical appropriateness, medical necessity and clinical risk management are met.
Key Activities:
- Authorizing hospital authorization requests by applying coding principles, medical scheme rules and benefits, and managed care policies and processes.
- Capture accurate pre-authorisation data on the system
- Educate and assist member by providing relevant clinical information to access the correct clinical benefits
- Consult member`s health care professional to make informed clinical decisions and manage financial risk
- Correctly escalate complex clinical call
- Provide excellent customer service
- Address all customer complaints in alignment with policies and procedures to achieve stakeholder buy-in
Education and Experience:
- Formal nursing qualification (SANC enrolled nurse) required
- 2 3 years experience in a general medical or general surgical ward, with at least 1 year at a private institution
- Minimum of 3 years in the clinical space required
- Must be computer literate
- Call centre experience advantageous
- Previous Managed Healthcare experience in a call centre environment advantageous
Company Description:
A highly respected company with many of the top medical schemes under their umbrella
Prospective Reviewer (Preauthorisation Consultant) position available in Western Cape, Cape Town. This job position was posted by Palesa Mbali Group. The job has been posted as a premium ad on 2024-11-24 at 13:06:53 in the Medical category
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