Pre-Authorisation Case Manager

Join our client's team as a Registered Nurse 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:

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

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

• Knowledge of DTP care plans.
• Medical Aid Scheme Act and Governance.
• iMed system knowledge.

• Medical Aid.