| Date | 2024-11-24 |
|---|---|
| Job Title | Medical Pre-Authorisation Consultant (Enrolled Nurse) |
| Employer | Qetello More Information |
| Salary | 30000 |
| Category | Medical |
| 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 Qetello
Medical Pre-Authorisation Consultant (Enrolled Nurse) position available in Gauteng, Pretoria. This job position was posted by Qetello. The job has been posted as a premium ad on 2024-11-24 at 13:21:45 in the Medical category
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