|Title||NURSE PRE-AUTHORISATION AGENT|
Ref 6803. One of our clients has an opening for a Pre-Authorisation Agent with at least 3 years experience and a sound understanding of the South African health industry.
Duties include, but are not limited to:
Providing pre-authorisation and patient management in line with clinical guidelines for members wishing to visit a healthcare provider.
Arranging appointments at an appropriate healthcare provider after pre-authorisation review.
Communicating difficult cases and/or possible utilisation abuse and fraud to Risk Management for further review.
Providing ongoing input on refining the pre-authorisation and patient management process.
Working with Risk Management to prioritise interventions and engage with healthcare providers and members to ensure optimal utilisation and care.
Other specific projects in line with qualifications and work experience.
Skills and requirements:
A recognised Diploma or Degree in Nursing.
Enrolled or Registered Nurse with the South African Nursing Council (SANC).
Clinical Risk Management certification or a similar education will be an advantage.
Must have at least 3 years experience as a Pre-Authorisation Agent.
ICD 10 coding, modifiers and RPL tariff knowledge and understanding.
Ability to liaise with external parties – clinicians and members.
A sound understanding of evidence-based medicine principles and embracing health economic principles and tools.
Please email a copy of your CV to email@example.com quoting the above reference no and if you do not hear from us within 2 weeks, please consider your application unsuccessful.