Discovery Jobs – Hospital Benefit Specialist

2 weeks ago


South Africa Discovery Limited Full time

Job Description:
The role will apply to working in various settings, predominantly casualty.

It is anticipated that the risk purpose will also extend into the general ward and high care/ICU settings as needed.

Coordinating the care of certain patients who are vulnerable to care gaps during transitions particular entry into hospital through to the emergency room, and discharge from hospital.

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Job Responsibilities:
Handling escalations from Providers and internal stakeholdersTrend Analysis of inefficiencies and proposals to correctEffective and accurate communication to all stakeholdersCase update to the providerSystems teams (issues experienced)

Appropriate internal case referrals for clinical managementFunding decisions and Benefit confirmations to the membersPreparing and presenting complex case to clinical reviewManaging the benefit for the member and the risk for the relevant scheme through approving or declining treatment to ensure that the member gets the appropriate level of careRequest for additional information from the treating doctorDischarge planning by providing the member with alternatives to receive treatmentJob Requirements:
Valid SANC RegistrationMatricMicrosoft Office (Specifically Excel experience)

Valid Driver's License and own transport3 years Clinical experience in a private hospital setting (ICU, Trauma/Casualty, Medical/General ward preferable)Effective Communication Skills (Verbal & Written)Must be a Registered NurseTelephone EtiquetteActive Listening Skills2 years Managed health care experienceJob Details:
Company:Discovery Limited

Vacancy Type:
Full Time

Job Location:
Gauteng

Application Deadline:
N/A(ads2)Apply

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