Pre-Authorisation Consultant

Introduction

Startek is global provider of customer support services, business process outsourcing (BPO), engagement solutions, integrating digital technologies, communication, and data to serve brands worldwide.

Our mission is to combine people, technology and data to deliver customer experience excellence for leading brands. We are currently hiring on behalf of one of our clients within the health administration sector.

Should your profile be a direct match for our vacancy.

Please do apply. Should you be in the market for vacancies within the health administration or managed care space and do not see a vacant role within your specialization, please email and include your specialization in the email subject title.

Duties & Responsibilities

The Pre-Authorisation Nurse provides hospital 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.

• Verifies eligibility of cover in accordance with medical scheme membership files and medical scheme rules.
• Required to work compress hours shift on a rotational basis.
• Authorises and facilitates admission of the member to a suitable facility subject to the clinical guidelines and protocols of the company.
• Authorises out of hospital visits to specialists.
• Establishes whether the member has any co-morbid conditions.
• Communicates with the admitting facility the details of the admission including the level of care, length of stay and value to the hospital as well as any conditions of the admission.
• Communicates with attending medical practitioner to request specific health information or discounts on specific procedures or equipment.
• Collaborates on a member's care plan in conjunction with other health professionals such as the Medical Advisor, other Case Management nurses within the organisation, dieticians, podiatrists, optometrists, behavioural health specialists, etc, as the case may be.
• Refers patients to Disease Management, where appropriate, during a hospital admission.
• Updates the computer system with the member's clinical and demographic details.
• Prepares, participates in discussions and presents cases at clinical meetings.
• Prepares reports and case summaries as needed.
• Plates special assignments and projects instrumental to the function of the department.
• Performs other duties as needed.

Desired Experience & Qualification

Skills and Competencies Required

Registration Requirements

Computer Literacy

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