Preauthorization Consultant (Enrolled Nurse)

About the role

The Preauthorization Consultant (Enrolled Nurse) is responsible for loading new authorisations and managing case enquiries by phone from admission through discharge. The role ensures accurate funding verification and provides seamless support to patients, healthcare providers and internal stakeholders.

Key responsibilities

• Pre‑authorise members' hospital admissions according to scheme protocols and funding guidelines.
• Capture and verify authorisation information to confirm correct funding.
• Analyse procedure codes and incorporate savings into daily pre‑auth reports.
• Handle DSP queries related to penalties and co‑payments.
• Initiate non‑declaration processes when required.
• Provide telephone and multi‑channel support to all key stakeholders until queries are resolved.
• Prepare and refer high‑cost or out‑of‑protocol cases for specialised case management.
• Stay updated on product changes and benefits to ensure service excellence.
• Meet and exceed performance metrics related to service delivery and call‑centre targets.

Required profile

• Enrolled Nurse qualification.
• Managed‑care experience is essential.
• Strong understanding of scheme protocols and funding guidelines.
• Excellent telephone communication and stakeholder management skills.
• High attention to detail and accuracy in data capture.

Required skills

• Knowledge of healthcare funding and authorisation processes.
• Ability to interpret medical coding and identify cost‑saving opportunities.
• Proficiency in data entry and record‑keeping systems.

What we offer

• Competitive remuneration up to R40,000 per month, inclusive of benefits.