Case Manager

2 weeks ago


Sandton, South Africa Discovery Ltd. Full time

**Business Unit**:Discovery Health**Function**:Risk Management**Date**:17 Aug 2023- Case Manager - Junior- About Discovery- Discovery’s core purpose is to make people healthier and to enhance and protect their lives. We seek out and invest in exceptional individuals who understand and support our core purpose, and whose own values align with those of Discovery. Our fast-paced and dynamic environment enables smart, self-driven people to be their best. As global thought leaders, Discovery is passionate about innovating in order to not only achieve financial success, but to ignite positive and meaningful change within our society.- About Discovery HealthCare Services (DHCS)- DHCS consists of six teams that are supported by dedicated Shared Services, Finances and DHCS Business Support teams. The teams under DHCS are:
- Executive Wellness
- Corporate Wellness
- Health Coaches
- Southern Rx Pharmacy and Discovery Medical Suppliers
- Home Care
- Corporate Clinics

Through its teams, DHCS aims to:

- Provide quality care by bridging the gaps in the current market with high quality services.
- Enhance the member journey through convenience, reduced co-payments and lessening the administrative burden.
- Realize scheme savings by identifying the opportunities to expand through supply chain and capture value through better procurement and eliminating waste.
- Brand differentiation by providing members with innovative services that leverage the latest health technology.
- Key purpose Key Outputs- Management of referrals and queues according to SLA including communication to doctors and patients regarding the status of the referral; and tracking of referrals on the relevant dashboards.
- Management of workflow pools according to SLA including loading and review of authorisations; communicating the authorisation numbers to nurses and patients; and actioning enrolments.
- Coordination of HomeCare patients/ nurses/ agencies/ which includes scheduling patient visits, procuring medication; creating patient records on the practice management system; communication to doctors, patients, and nurses; managing queries and escalations.
- Team support to the nursing personnel.
- Review of clinical reports (under supervision from senior team members) and communication thereof to the relevant doctors.
- Generation and review of invoices for the patient visits by the HomeCare nurses.
- Dashboard and tracker compilation and review.
- Call Center management within the shift allocated.
- Competencies- Communication
- Innovation
- Tenacity
- Drive
- Time Management
- Ability to work effectively within a team and independently.
- Experience, qualifications, and mandatory requirements- Matric
- Minimum 2-year Call Center experience.
- Discovery Health products and system knowledge.
- Effective Communication Skills (Written & Verbal in English and Afrikaans).
- Be able to use MS Office.
- Call Center/Hunt Line experience.
- Telephone skills.
- ICD10/CPT/BHF coding knowledge.
- Protocol knowledge and knowledge on how to research information on DNA/PinPoint.
- Be able to work flexible hours.
- Advantageous- Claims and billing knowledge
- Knowledge of the area
- Management of escalated queries
- EMPLOYMENT EQUITY
The Company’s approved Employment Equity Plan and Targets will be considered as part of the recruitment process. As an Equal Opportunities employer, we actively encourage and welcome people with various disabilities to apply.



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