Key PurposeThe successful applicant will be responsible for but not limited to the following job functionsAssessing the case in relation to the followingMembers clinical history Members benefit structure Clinical Information and coding supplied Level of care provided Appropriateness of the facility Appropriateness of the treating doctor Appropriateness of treatment Managing the benefit for the member and the risk for the relevant scheme through a thorough process to approve or decline Funding to ensure that the member gets the appropriate level of care Discharge planning by providing the member with alternatives to receive treatment (This includes Hospital @ Home, Homecare etc.)
Effective and accurate communication to all stakeholdersCase update to the provider Funding decisions and benefit confirmation to the members Request for additional information from the treating doctor or practice manager Engaging with Patient Services Manager and hospital staff Handling escalations from Providers and internal stakeholders Preparing and presenting complex case to clinical review Trend Analysis of inefficiencies and proposals to correct Appropriate internal case referrals for clinical management
Operational TargetsAttend to patients on daily report Review all low acuity admission requests Quality of processes
Education and Experience:
The following requirements are essentialMatric Must be a Registered Nurse Valid SANC Registration 3 years Clinical experience in a private hospital setting (ICU, Trauma/Casualty, Medical/General ward preferable) 2 years Managed health care experience Microsoft Office (Specifically Excel experience) Valid Driver’s License and own transport ( working hours are between 08:30 -17:00 & travel up to 50KM may be required) Effective Communication Skills (Verbal & Written) Telephone Etiquette Active Listening Skills
The following requirements are advantageous1 – 2 years ICU experience Knowledge of DH SOP’s and Process experience (internal only) Provider payment arrangements (internal Only) Clinical coding knowledge of ICD-10 and/or CCSA
Personal Attributes or Competency Profile
The Discovery Person
Values Driven Optimistic Learns on the Fly Resilient Instils Trust People Savvy Drives Results Problem Solver
How To Apply
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Make sure you are logged in and your email is verified(Register if you dont have an account).
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Click the Apply Now button above.
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Your default email application or application link will open.
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Attach your Application letter, updated Curriculum Vitae (CV) and any supporting documents required.
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Use a professional subject line such as Application for "Indicate Positions"
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Send your application before the closing date.
Note: Only shortlisted candidates are contacted.
