Description
The Dental Pre-Authorisation Nurse is responsible for dental utilisation management, clinical review, education/training, and other clinically based activities as assigned and coordination of care between the medical aid fund/managed care organisation, members, healthcare providers, and the broader healthcare network. The role ensures that dental treatments are clinically appropriate, cost-effective, and aligned with fund rules and clinical protocols.
Duties and Responsibilities

• Verifies eligibility of cover in accordance with medical scheme membership files and medical scheme rules.
• Assesses, authorises and facilitates dental treatment subject to clinical guidelines, protocols and benefit structures.
• Communicates with the treating providers the details of the authorised treatment, benefits available and Namibian Dollar value of the proposed treatment.
• Capture and update the member’s clinical and demographic details on the systems.
• Prepares case summaries, participates in discussions and presents cases to the Dental Advisor.
• Provide clinical input and prepare reports and case summaries as needed.
• Completes special assignments and projects instrumental to the function of the department.
• Performs other duties as needed.

Required profile for job ad : Dental Nurse - Windhoek

Experience and Qualifications Required

• Minimum of 3 – 5 years’ experience in a call centre environment within a medical scheme or managed care environment.
• Dental Nursing qualification and experience would be an advantage.
• Strong verbal and written communications skills.
• Customer service focus.
• Ability to solve problems in a customer friendly manner.
• Working knowledge of the Namibian healthcare system, including medical aid operations and healthcare funding models.

Language Requirements

• English: Primary business language. Be able to speak, write, spell, read and comprehend the language
• Being able to speak, write, spell, read and comprehend in other languages would be an advantage.

Computer Literacy

• Proficiency with the following programmes is required:
• MS Word
• MS Excel
• MS Outlook / email
• MS Explorer / Internet
• Some prior knowledge/experience in the use of a medical aid administration or managed care system.

Registration Requirements
Current and continued registration with the HPCNA.
Work Requirements

• The position is based in Namibia
• Own transport is essential
• Willingness to work long hours when required is a requirement

Remuneration
A competitive salary and benefits will be negotiated, consistent with experience and the role and responsibilities of the position.