Pre authorization Case manager at M&M Consulting - Gauteng, Sandton - Sandton
M&M Consulting Services and Talent Acquisition
Pre authorise member's admission to hospital as per scheme protocol and guidelines Capture authorization on IMED system Liaise with medical advisor Handle hospital updates telephonically and via e-mails Telephonic and e-mail case management and referral of cases for Specialised case management as per guidelines Monitoring of ongoing hospital cases and final updates including negotiating for discounts Handle member's queries regarding hospitalization and benefits Handle written communication and motivation reports including correspondence Manage cost containment of hospital incidents/admissions Ensure maintenance of call centre SLA Liaise with hospitals, doctors, members and family members Work with other healthcare personnel within the organisation Provide clinical expertise within the organisation Key: Responsibilities 1.Pre authorize member's admissions to hospital according to scheme benefits and departmental protocols and guidelines. 2. Manage high care and general ward cases up to a rand value of R70 000. 3. Telephonic case management of surgical cases up to a rand value of R80 000 and medical cases to R60 000 excluding joint replacements Desired Skills: enrolled nurse Medical Schemes act Desired Work Experience: 2 to 5 years Social Worker Desired Qualification Level: Diploma
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