|Reference #||Sandra Minne|
|Location||Pretoria, Gauteng, South Africa|
The position was added to the new structure
Responsible for providing guidance and leadership to ensure the effective functioning of the following divisions:
Pre-authorisations – the call centre where clinical staff are responsible for authorising benefits and hospital admissions, requests for specialised radiology and general
Non-disclosures – the division responsible to investigate members who request benefits for medical services requiring pre-authorisation within their first year of membership;
Indexing (admin support assistants) – the division responsible for the correct and timeous allocation of workflow documents received; and
Systems Development – the division responsible for liaising with IT on system requests, specifications, User Acceptance Testing (UAT) and quality assurance.
Liaise with decision makers to ensure that protocols are applied correctly and stay abreast of changes in the medical industry.
Continuous improvement of business processes, e.g. automation of system driven pre-authorizations.
Liaise with external clients
Draft, review and negotiate contracts with third-party service providers to ensure delivery of services required.
Ensure constant operational efficiency through innovation within areas under control.
Ensure adherence to all legislative and regulatory prescripts.
Continuously evaluate operational plans, actions and resources to ensure that objectives are achieved.
Manage the budget in order to utilise resources effectively and achieve objectives.
A completed degree/diploma as a registered nurse.
Registered with the SANC.
Eight years’ relevant experience, of which at least two years should be in a managed healthcare environment.
The candidate must also have at least two years’ clinical nursing experience and four years’ experience in a senior supervisory capacity.
Must possess knowledge of the following:
Medical Schemes Act;
IT systems and processes;
ERP, workflow and HBM systems; and
CPT-4, ICD-10 and RPL codes.
Computer literate in MS Office.
Must possess a valid K53 driving licence.
Good verbal and written English communication skills as well as proficiency in understanding Afrikaans spoken and written communication.
Must possess the following skills:
Technical knowledge and professional skills;
Good interpersonal relations and customer focus;
Able to function well under pressure; and
Organising and coordination skills.
|Job Closing Date||14/06/2021|