Job Description
Position Purpose: To ensure the accurate issuing of appropriate pre-authorisations that meets the requirements of clinical appropriateness, medical necessity and clinical risk management.
Experience: A minimum of 2-3 years’ experience in Managed Healthcare will be advantageous.
Qualifications: A formal nursing qualification and registration/enrolment with SANC or a formal healthcare professional qualification (Registered / Enrolled Nurse). (MANDATORY REQUIREMENT) KEY PERFORMANCE AREAS Advise on best practice health risk solutions to relevant parties Application of clinical intervention principles Excellent understanding of Call Centre technology Application of financial and risk assessment methodology Authorise hospital authorisation requests by applying coding principles, scheme rules and benefits, and managed care policies and processes Capture accurate pre-authorisation data on the system Correctly escalate complex clinical call Meet delivery objectives through ...