Job Title: Pre-Authorization Case Manager
Company:Fusion Personnel
Job description: Well-established company in Johannesburg North seeks a Pre-Authorization Case Manager to join their team!Purpose of the Role:
Responsible for managing hospital admissions telephonically, ensuring appropriate authorization, monitoring patient progress, and controlling costs according to established protocols.Requirements:
- Qualifications: Nursing diploma (registered or enrolled nurse).
- Experience: 3-5 years of nursing experience; prior pre-authorization experience in managed healthcare is beneficial.
- Technical Knowledge: Understanding of PMB conditions, DTP care plans, hospital types, medical coding (ICD-10, CPT), and government regulations.
- Skills: Attention to detail, strong communication, teamwork, organizational skills, and computer literacy.
Key Responsibilities:
- Approve hospital admissions based on guidelines.
- Manage general ward and high-care cases.
- Oversee surgical and medical cases.
- Capture authorizations in the IMED system.
- Coordinate with medical advisors, hospitals, doctors, and patients.
- Provide telephonic case management and referrals for specialized cases.
- Monitor ongoing hospital cases, negotiate cost reductions, and ensure final updates.
- Handle member queries regarding hospitalization and benefits.
- Ensure compliance with service level agreements (SLA’s).
- Maintain professional communication across departments.
Expected salary: R450000 – 495000 per year
Location: Johannesburg, Gauteng
Job date: Mon, 17 Feb 2025 06:53:18 GMT
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