Pre-Authorisation Consultants HBM

About the position

Our client, in Managed Care, seeks to employ an Enrolled Nurse for the accurate issuing of appropriate Pre-Authorisations that meets the requirements of clinical appropriateness. The role is performed in a contact centre.

Key requirements:

• Enrolled Nurse with SANC.
• Minimum of 5 years experience as a nursing practitioner (ICU/ theatre experience).
• 1 year experience gained in the medical funding industry (essential).
• Medical Scheme-related experience in Hospital Benefits Management required.

Key responsibilities:

• Delivering cost-effective managed healthcare services to accomplish member satisfaction.
• Deliver an effective call centre service in order to achieve member satisfaction.
• Reduce the risk associated with hospital and authorised cases.
• Telephone etiquette, Answering calls in a way that achieves member satisfaction.
• Verifying prosthesis limits, to contain costs for both members and fund.
• Evaluating treatment, LOS and LOC.
• Knowledge of current coding systems (ICD10's, CPT4, NRLP, and HBM conditions).

To apply, email copies of your supporting documents together with your CV to response "at" [URL Removed] or call us on [Phone Number Removed];.

Supporting documents required:

• Copy of SANC receipt
• Copy of ID
• Copy of latest pay slip
• Copy of qualification(s) and Matric

Desired Skills:

• 1 year experience gained in the medical funding industry (essential).

Desired Qualification Level & Accreditations:

• Diploma
• South African Nursing Council