Clinical Pre-Authorization Specialist

Private Health Administrators (Pty) Ltd; Centurion; On-site; ZAR 250,000 - 360,000; Full time

Job summary

Private Health Administrators (Pty) Ltd seeks a qualified nurse to issue accurate pre-authorisations, ensuring clinical appropriateness and risk management. A formal nursing qualification with SANC registration or equivalent healthcare credential is mandatory, with 2–3 years in managed healthcare preferred.

The role involves data capture, call centre interactions, and applying scheme rules to authorise hospital requests.

Qualifications

• Formal nursing qualification with registration/enrolment with SANC or equivalent healthcare qualification (mandatory).
• Minimum 2–3 years’ experience in Managed Healthcare is advantageous.
• Knowledge of health risk solutions and clinical intervention principles will be beneficial.

Responsibilities

• Advise on best practice health risk solutions to relevant parties.
• Apply clinical intervention principles in daily decisions.
• Capture accurate pre-authorisation data in the system.
• Authorise hospital authorisation requests per scheme rules and policies.
• Escalate complex clinical calls when needed.
• Collaborate with team to meet delivery targets and overall department objectives.

Skills

Emails / HIP / Excel / Word

Negotiation

Telephone Skills

Communication Skills

Business Writing

Systems knowledge

Negotiation & Influence

Problem Solving

Numerical Ability

Customer Focus

Attention to Detail

Education

Nursing qualification with SANC registration or healthcare professional qualification

Job description

Private Health Administrators (Pty) Ltd seeks a qualified nurse to issue accurate pre-authorisations, ensuring clinical appropriateness and risk management. A formal nursing qualification with SANC registration or equivalent healthcare credential is mandatory, with 2–3 years in managed healthcare preferred.

The role involves data capture, call centre interactions, and applying scheme rules to authorise hospital requests.