Pre-Auth Case Manager at AfroCentric Group

Brief Role Description

• To ensure the accurate issuing of appropriate pre-authorisations that meets the requirements of clinical appropriateness, medical necessity and clinical risk management

Duties and responsibilities for this role:

• Providing Accurate Pre- Authorisation in accordance to coding principles, scheme rules and benefits, and managed care policies and processes
• Providing Clinical review and resolution on call centre queries
• Review and process auth related claims in accordance with coding principles, scheme rules and benefits, and managed care policies and processes
• Communicate with Stake holders  
• Writing of clinical reports
• Maintain clinical documents and processes
• Assist with training and sharing of knowledge within the team and clients

Competencies

• Attention to Accuracy and Detail
• Ability to negotiate and influence
• Ability review clinical request and advise scheme and colleagues
• Ability assess claims for clinical correctness according to authorisation provided
• Relevant systems knowledge and application
• Problem Solving
• Customer centred and Focussed
• Computer Technology Skills
• Communication Skills
• Clinical reporting skills
• Business Writing Skills
• Numerical Ability

Qualifications:

• A formal nursing qualification and registration/enrolment with SANC or a formal healthcare professional qualification (Registered / Enrolled Nurse).

Experience

• A minimum of 2-3 years’ experience in a general medical and general surgical ward. At least 1 of these years at a Private institution.
• Trauma/ER experience will be an advantage. Previous Managed Healthcare experience in a call centre environment will be to your advantage.
• SANC Membership