Prospective Reviewer (Preauthorisation Consultant)

Details of the offer

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 systemEducate and assist member by providing relevant clinical information to access the correct clinical benefitsConsult member's health care professional to make informed clinical decisions and manage financial riskCorrectly escalate complex clinical callProvide excellent customer serviceAddress all customer complaints in alignment with policies and procedures to achieve stakeholder buy-inEducation and Experience:Formal nursing qualification (SANC enrolled nurse) – required2 – 3 years' experience in a general medical or general surgical ward, with at least 1 year at a private institutionMinimum of 3 years in the clinical space requiredMust be computer literateCall centre experience advantageousPrevious Managed Healthcare experience in a call centre environment – advantageousCompany Description:A highly respected company with many of the top medical schemes under their umbrella


Nominal Salary: To be agreed

Source: Whatjobs_Ppc

Job Function:

Requirements

Llb Admitted Attorney

We are a newly established law firm in partnership with prominent banks, specializing in property law and bond registrations. We are looking for a dynamic an...


West Coast Personnel - Western Cape

Published 13 days ago

Legal Transactions Project Specialist

REQUIREMENTSMatric, bachelors degree in lawAt least 3 years post qualification experience with financial deals/ transactions either within a Banking and Fina...


Time Personnel - Western Cape

Published 13 days ago

Banking & Finance Lawyer

COMPANY PROFILE Cognia seamlessly extends corporates, banks and law firms' legal capability to deliver sustainable outcomes. Our goal is to connect the legal...


Cognia Law - Western Cape

Published 12 days ago

Compliance Analyst

Responsibilities:Market data analysisPortfolio managementProject managementCompliance InvestmentsRegulation reportingClient servicesRegulatory frameworksSkil...


Communicate Recruitment - Western Cape

Published 12 days ago

Built at: 2024-12-23T14:35:39.320Z