Grade: B3M2
Salary : R355k – R410k
Location : Johannesburg & Cape Town
Position Purpose:
Our Client is seeking dedicated and experienced prospective reviewers to join their team. Your role will be pivotal in ensuring the accurate issuance of appropriate pre-authorizations that meet the requirements of clinical appropriateness, medical necessity, and clinical risk management. This position plays a crucial role in optimizing patient care and resource management.
Key Responsibilities:
- Evaluate pre-authorization requests to ensure they align with clinical appropriateness and medical necessity.
- Assess clinical risks and provide recommendations for appropriate patient care.
- Collaborate with healthcare providers to ensure the right level of care is authorized.
- Maintain accurate and detailed records of all pre-authorization activities.
- Participate in ongoing training and development to stay updated on clinical best practices and managed healthcare protocols.
- Communicate with patients, healthcare providers, and other stakeholders to facilitate pre-authorization processes.
- Contribute to the continuous improvement of managed healthcare services.
Experience:
- A minimum of 2-3 years of experience in a general medical and general surgical ward.
- At least 1 year of experience at a private institution.
- Trauma/ER experience will be an advantage.
- Previous managed healthcare experience in a call center environment will be beneficial.
Qualifications:
- Nursing Degree/Diploma.
- A formal nursing qualification and registration/enrollment with the South African Nursing Council (SANC).
Qualities and Skills:
- Strong clinical assessment and decision-making abilities.
- Excellent interpersonal and communication skills.
- Attention to detail and accuracy in documentation.
- Knowledge of healthcare regulations and compliance.
- Ability to work collaboratively in a fast-paced environment.
- Commitment to patient-centered care and responsible resource management.
Application Deadline: 11th December 2023