Pre-Authorisation Case Manager

Join our client's team as a Pre-Authorisation Consultant, where you will be responsible for telephonic Case Management ensuring that cases are monitored from admission to discharge, providing a comprehensive understanding of patient progress.
Key Performance Areas:

1. Pre-Authorisation of member hospital admissions based on scheme benefits and departmental protocols.
2. Manage high care and general ward cases.
3. Telephonic Case Management of surgical and medical cases.

Job Key Responsibilities:

1. Pre-authorise hospital admissions and capture details on the IMED system.
2. Communicate with medical advisors for accurate case management.
3. Provide hospital updates and manage cases via phone and email.
4. Refer cases for specialised management as required.
5. Monitor ongoing hospital cases and negotiate discounts.
6. Address member queries related to hospitalisation and benefits.
7. Manage written communication, including motivation reports.
8. Ensure cost containment of hospital admissions.
9. Maintain call centre SLA compliance.
10. Collaborate with hospitals, doctors, and members.
11. Provide clinical expertise to the organisation and assist healthcare personnel.
12. Manage high-care and general ward cases, including rehabilitation and step-down admissions.
13. Negotiate discounts for prosthetics and report cost savings.

Desired Skills:

1. Knowledge of DTP care plans.
2. Medical Aid Scheme Act and Governance.
3. iMed system knowledge.