Dental Pre-Authorisation Nurse – Hospital Care

Universal Healthcare; Johannesburg; On-site; ZAR 300,000 - 450,000; Full time

Job summary

A leading healthcare company seeks a Dental Preauthorisation Nurse to manage dental utilisation processes, including eligibility verification and treatment authorisation. With a focus on communication and customer service, the role involves collaboration with healthcare providers and managing system updates. Candidates should have a nursing qualification and relevant experience within the medical scheme industry.

Qualifications

• Minimum of 3-5 years experience in a call center within a medical scheme or managed care.
• Experience in dental nursing is preferred.
• Understanding of the South African healthcare industry.

Responsibilities

• Verifies eligibility of cover according to medical scheme membership.
• Authorises dental treatment based on clinical guidelines.
• Updates the system with clinical and demographic details.

Skills

Strong verbal and written communications skills

Customer service focus

Problem-solving ability

Education

Dental Nursing qualification

Job description

The Dental Preauthorisation Nurse provides dental utilisation management, education/training, and other clinically based activities as assigned, to coordinate care between the medical scheme/managed care organisation, members, providers and the community.

Duties and Responsibilities

Verifies eligibility of cover in accordance with medical scheme membership files and medical scheme rules.

Authorises and facilitates dental treatment subject to the clinical guidelines and protocols of the company.

Communicates with the treating providers the details of the authorised treatment, benefits available and Rand value of the proposed treatment.

Updates the computer system with the member’s clinical and demographic details.

Prepares, participates in discussions and presents cases to the Dental Advisor.

Prepares reports and case summaries as needed.

Completes special assignments and projects instrumental to the function of the department.

Performs other duties as needed.

Experience and Qualifications Required

Minimum of 3 – 5 years’ experience in a call centre environment within a medical scheme or managed care environment.

Dental Nursing qualification and experience would be an

Strong verbal and written communications skills.

Customer service focus.

Ability to solve problems in a customer friendly manner.

Understanding of the SA healthcare industry and the use of medical scheme / healthcare financing terminology.