Preauthorisation Nurse

 Affinity Health Vacancies

Preauthorisation Nurse Position

Job Description

Affinity Health Vacancies | Preauthorisation Nurse

Job Location: Gauteng
Job Sector: Healthcare
Job Type: Permanent
Job Salary: R30 000.00 – R35 000.00 Per Month

Preauthorisation Nurse
Affinity Health

Affinity Health is seeking experienced Preauthorisation Nurses to join our team in Benoni. This role involves evaluating the legitimacy of medical service or treatment requests from members or providers, ensuring timely, client-centered decisions aligned with set protocols.

Key Responsibilities

Authorise or Decline Medical Services/Treatment
• Validate member eligibility, benefits, and plan coverage.
• Confirm compliance with policies, exclusions, waiting periods, and benefit limits.
• Approve or decline requests per protocols and benefit guidelines.
• Conduct security checks before sharing information.
• Refer cases to the clinical review team as needed.

Mitigate Waste or Abuse of Benefits
• Assess preauthorisations for GP/specialist visits, ER care, diagnostics, and hospitalizations.
• Request medical documentation (e.g., history, accident reports) to finalize decisions.
• Verify continuation of benefits and coverage limits.
• Identify non-disclosed pre-existing conditions.
• Ensure requests align with guidelines, formularies, and provider agreements.
• Promote cost-effective network providers and alternative facilities (e.g., day clinics, home nursing).
• Escalate cases requiring clinical review.
• Advise members/providers on policy terms, benefits, and preferred providers.
• Stay updated on scheme rules, legislation, and system changes.

Administrative Duties
• Prioritize urgent authorization requests and queries.
• Process upfront payments per protocols and assess urgency.
• Accurately capture data on operational systems.
• Communicate authorization outcomes to members/providers verbally/written.
• Handle appeals and complaints, escalating when necessary.
• Use the Intranet for updated documents and maintain confidentiality.
• Adhere to policies, SLAs, turnaround times, and QA standards.

Candidate Requirements

Essential Experience
• Managed Healthcare in a Contact Center environment.
• Theatre or ICU experience.

Essential Qualifications
• Matric certificate.
• Nursing Diploma/Degree (Registered Nurse).

Legal Requirements
• Valid SANC registration.

Other
• Fluency in Afrikaans (written and spoken).

Knowledge and Skills
• Proficient in MS Office.
• Strong administrative skills.
• Understanding of ICD, BHF, and CPT codes.

Attributes
• Professional, flexible, and detail-oriented.
• Accountable, honest, hardworking, and humble.

Please note: Applications not responded to within two weeks will be considered unsuccessful.

APPLY NOW

How to Apply

To apply for this position, click the “Apply Now” button or follow the specific instructions provided in the job description. Ensure that your CV and supporting documents are up to date and relevant to the position. You can also visit the company website for more information and opportunities.

Please note: This job posting may be closed at any time by the employer, either due to internal recruitment policies, legal requirements, or once a suitable candidate has been found. We encourage you to apply as early as possible.

Only shortlisted candidates will be contacted.