Pretoria: Clinical Pre-Authorisation Consultant posted by Qetello
Posted on 2025-06-17 00:00:00
| Employer | Qetello |
|---|---|
| Category | Other Medical |
| Location | Gauteng / Pretoria |
Job Summary
Our client is seeking a Clinical Pre-Authorisation Consultant to join their dynamic team. If you’re a healthcare professional registered with the South African Nursing Council (SANC) as a Registered Nurse, with at least two years of experience in Managed Healthcare or Private Hospital settings, we encourage you to apply!
Key Responsibilities:
Application Review: Process and evaluate pre-authorisation applications.
Telephonic Authorisations: Handle pre-authorisations for hospital and radiology services through the call center.
Data Entry & Verification: Accurately capture and verify clinical details, including ICD-10 and item codes.
Membership Validation: Confirm membership status and available benefits prior to granting authorisation.
Special Requests: Assess and process special pre-authorisation applications.
Coding Accuracy: Apply appropriate coding before approving benefits.
Clinical Interpretation: Analyse medical reports and doctors’ motivations.
Information Sharing: Provide patients and service providers with clear, relevant information on scheme rules, benefits, and approvals.
Benefits Management: Approve benefits in line with benefit options and protocols to mitigate scheme risks.
Record Keeping: Maintain accurate records of all transactions and documentation.
Service Excellence: Deliver outstanding service to members and providers.
Continuous Learning: Stay updated on scheme rules, benefit options, legislation, protocols, and system changes.
Requirements:
Education: Minimum Grade 12 certificate.
Nursing Qualification: Degree or diploma in nursing; registered with SANC.
Experience: At least two years in a private hospital or managed healthcare setting.
Knowledge:
Medical Schemes Act.
Proficiency in CPT-4 and ICD-10 coding, with RPL knowledge.
Skills:
Strong technical and professional capabilities.
Exceptional time and work management.
Outstanding customer focus.
Fluent in English (spoken and written) with understanding of Afrikaans.
Proficient computer literacy.
Interpersonal Abilities:
Effective team collaboration.
Conflict resolution skills.
Flexibility: Willingness to cross-train in other managed care sections.
How to Apply:
Interested candidates who meet the requirements are invited to submit their CV and supporting documents to *****@*****.co.za with the subject line REF: Pre-Auth
Please note: If you have not received feedback within two weeks of your application, consider your application unsuccessful.
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: Accountant posted by Third Age Group
Location Pretoria, GautengAre you an experienced accounting professional with a strong leadership background and a passion for financial excellence? We are...
View Job
Accountant
Pretoria East: Welder – Urgently needed posted by Honeyfields
Welder with experience wanted on a construction site in Pretoria East. Must have done stainless steel and mild steel welding.
View Job
Welder – Urgently needed
Pretoria East: Welding – Stick welding posted by Honeyfields
We are looking for a Welder with experience in stick steel welding , in Pretoria East. Must preferably have done mild steel and stainless steel welding.
View Job
Welding – Stick welding
Pretoria East: Teacher posted by Kleinmensies Kleuterskool
Teacher required for 2 to 3 year old kids.Qualification required or in processPractical experience at Pre-primary schoolsFull day Monday to FridayPost...
View Job
Teacher
Pretoria East: Accountant – URGENTLY needed posted by Staffworx Recruitment
RECRUITING! EXCELLENT OPPORTUNITY!Job Title Accountant Location Lynnwood, Pretoria-East with minimum 5 times per month in Rustenburg Department Finance...
View Job
Accountant – URGENTLY needed
Pretoria East: Finance Intern posted by MGM VIP SECURITY
Job Summary Were looking for a motivated and detail-oriented Finance Intern with some prior experience to join our finance team. This is a fantastic...
View Job
Finance Intern
Pretoria: Town planner posted by IF Property Solutions (Pty) Ltd
IF Property Solutions Pty Ltd based in Pretoria, is expanding and in need of a qualified Town Planner.If you are based in Pretoria and meet all the...
View Job
Town planner
Pretoria North: Driver – Urgent posted by Alwinco
Job Opportunity Contract Driver Wanted at AlwincoAlwinco, South Africas leading independent security risk assessment company, is looking for a reliable...
View Job
Driver – Urgent
Pretoria City: Customer Service Representative – Fully Remote posted by Isisekelo Solutions
About the ClientOur client is a rapidly growing, remote-first company featured on Y Combinators Top Companies list. With a diverse global team and a...
View Job
Customer Service Representative – Fully Remote
Pretoria East: Showroom and order fulfillment assistant posted by Star Sweepers
Were Hiring! Showroom Order Fulfillment AssistantAre you a go-getter with a passion for organization, customer service, and a fast-paced work environment?...
View Job
Showroom and order fulfillment assistant
Pretoria East: Data Capturer/Admin posted by Anje Zondagh
Temp Position Junior Admin debtorscreditors clerk position to process medical claims. Capturing of data, liaising with Medical aids and patients. Comp...
View Job
Data Capturer/Admin
Pretoria: TETA Assessors – Registered TETA assessors needed posted by Health and safety Exodec Training
Registered assessors and moderators needed for freelance training with own transport. Please send CV and accreditation letter.
View Job
TETA Assessors – Registered TETA assessors needed
Pretoria East: Personal Assistant posted by Cora O’Neil Recruitment Agency
Ashlea Gardens, Pretoria PERSONAL ASSISTANTMinimum Requirements-Mature, presentable and professional Afrikaans speaking preferably female, aged 35...
View Job
Personal Assistant
Pretoria: Legal Admin Assistant posted by Cora O’Neil Recruitment Agency
Brooklyn, Pretoria LEGAL SECRETARY ADMIN ASSISTANTMinimum Requirements-Well presentable and professional, non smoking, Afrikaans speaking female Aged 45...
View Job
Legal Admin Assistant
Pretoria City: Catering Manager – Urgently needed posted by E Job Recruitment
Duties ResponsibilitiesTake full responsibility and management of the unitNeed to be able to work in a demanding environmentSetting and management of...
View Job
Catering Manager – Urgently needed
Pretoria City: ARMED REACTION OFFICER – URGENTLY NEEDED posted by HMA HIGH RISK SECURITY
Minimum 12 months experience as an armed reaction officerMust have PSIRAHandgunshotgun competencyClear criminal recordPolice clearanceJob referencesMust...
View Job
ARMED REACTION OFFICER – URGENTLY NEEDED
Pretoria City: Massage Therapist posted by HealthClinic
Massage therapist needed with 2 years experience. Must be willing to work under instruction.Preferably an Afrikaans speaking person.Preferably a Non-smoker...
View Job
Massage Therapist
Pretoria East: Malawian housekeeper – Urgent needed posted by Pro Decor
Job general house cleaning, washing, ironing, car wash, vacuum. Organize house and garage. Attend to garden and pool. Look after dogs.Stay in, full time,...
View Job
Malawian housekeeper – Urgent needed
Centurion: Sales executive – Urgently needed posted by Williams Hunt Pretoria
Large motordealer looking for Experienced salesperson.Need proven track record. Must have experience in motorsales.Basic with commission and company perks.
View Job
Sales executive – Urgently needed
Pretoria: Electrical Technician – Urgently needed posted by Dezan Projects (Pty) Ltd
Die ideale kanidaatGekwalifiseerde elektrisien Hardwerkend, eerlik, energiek, entosiasties. Bestuurs lesensie en eie vervoer sal voordelig wees.Konstruksie...
View Job
Electrical Technician – Urgently needed
Pretoria East: Aesthetician – Urgently posted by The Beauty Palace
We require 3 aestheticians min 3yrs Diploma. Basiccom benefits. Babor,Environ,Guinot,RegimA,Lamelle and Nimue skin products knowledge.
View Job
Aesthetician – Urgently
Pretoria East: Three Beauty Therapists – Urgently posted by The Beauty Palace
We require 3 beauty therapists with min 3yrs Diploma. Basiccom benefits. Babor,Environ,Guinot,RegimA,Lamelle, and Nimue skin products knowledge needed.
View Job
Three Beauty Therapists – Urgently
Pretoria East: Sales managers posted by K-Sel Industries
Sales managers neededAuthorised Kirby agentWe are looking for sales managers who are driven and self motivated, to go out and see clients, make...
View Job
Sales managers
Pretoria: Receptionist posted by Intercon Recruitment
A busy and reputable motor dealership based in Silver Lakes, Pretoria, is seeking a well-presented and professional Receptionist to join their team. The...
View Job
Receptionist
Pretoria City: Assistant Manager posted by Total Wonderboom South
FUEL STATION ASSISTANT MANAGER R12000 R15000REQUIREMENTS-Grade 12 -Preferably have previous retail experience -Valid drivers license and own...
View Job
Assistant Manager