Pre-Authorization Case Manager

Recruiter:

Fusion Personnel

Job Ref:

JHB005284/Maris

Date posted:

Saturday, February 15, 2025

Location:

Johannesburg, South Africa

Salary:

450000 Annually

SUMMARY:
Well-established company in Johannesburg North seeks a Pre-Authorization Case Manager to join their team!

POSITION INFO:
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.

Similar jobs you might be interested in:

Enrolled Nurse (x3 - Wits PHRU)
Location: Soweto
Salary: Annually
Background: The Perinatal HIV Research Unit (Wits PHRU) was established in 1996. The Perinatal HIV Research Unit has been involved in research, training, policy formation, and advocacy in issues concerning HIV-positive women and their children. In recent years, the work of the unit has expanded beyond the original focus of mother-to-child transmission of HIV.Main purpose of the job:To assist the r...
1 day ago

Professional Nurse - Wits PHRU
Location: Soweto
Salary: Annually
Background: The Perinatal HIV Research Unit (Wits PHRU) was established in 1996. The Perinatal HIV Research Unit has been involved in research, training, policy formation, and advocacy in issues concerning HIV-positive women and their children. In recent years, the work of the unit has expanded beyond the original focus of mother-to-child transmission of HIV. Main purpose of the job:To assist...
1 day ago

Pre-Authorization Case Manager
Location: Johannesburg
Salary: 450000 Annually
Well-established company in Johannesburg North seeks a Pre-Authorization Case Manager to join their team!
7 days ago

Registered Nurse - Medical - (Plettenberg Bay)
Location: Garden Route
Salary:
A private hospital in Plettenberg Bay is seeking a Registered nurse in the Medical Unit.
8 days ago

Registered Nurse - ICU Experienced (Plettenberg Bay)
Location: Garden Route
Salary:
Our client, a private hospital in Plettenberg Bay is looking for a Registered nurse with ICU experience to join their team
8 days ago

REGISTERED NURSE: Theatre (Scrub Nurse) - Plettenberg Bay
Location: Garden Route
Salary:
Our client, a private hospital in Plettenberg Bay is seeking a dedicated and experienced Registered nurse to join the healthcare team as a Theatre Scrub nurse. The successful candidate will play a vital role in providing high-quality, cost-effective, and safe patient care in accordance with hospital standards and policies.
8 days ago

BUSINESS UNIT GENERAL MANAGER (GAUTENG)
Location: Johannesburg
Salary:
To lead and manage a business unit in alignment with the company’s strategic vision, ensuring sustainable profitability. The role focuses on fostering a strong people-centric culture, enhancing customer relationships, and driving innovation within the organization.
1 day ago

General Manager / Operations Manager
Location: Johannesburg
Salary: 50 000 Monthly
A dynamic organization based in the East Rand is looking to employ a general / Operations Manager with experience working in a production manufacturing environment with 5 years’ experience in a similar role
1 day ago

General Manager: Finance
Location: Johannesburg
Salary: R2 200 000
Lead the Way in Engineering Finance – Become Our general Manager and Drive Strategic Financial Excellence!
3 days ago

General Manager (Automotive)
Location: East Rand
Salary: 50000 Monthly
Well-established company based on the East Rand seeks a general Manager from Automotive to join their team!
3 days ago