Discovery Limited Healthcare Jobs in Eastern Cape
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Key Purpose:
- The successful applicant will be responsible for but not limited to the following job functions:
Responsibilities
Assessing the case in relation to the following:
- Members 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.)
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Effective and accurate communication to all stakeholders
- Case 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 Targets:
- Attend to patients on daily report
- Review all low acuity admission requests
- Quality of processes
Competencies:
The successful candidate must demonstrate the following competencies:
Role Specific Behaviours
- Ensures accountability.
- Action oriented
- Manages ambiguity.
- Attracts top talent.
- Business insight
- Collaborates
- Communicates effectively.
- Manages complexity.
- Manages conflict.
- Courage
- Customer focus
- Decision quality
- Develops talent
- Values differences
- Directs work.
- Drives engagement
- Financial acumen
- Global perspective
- Cultivates innovation.
- Interpersonal savvy
- Builds networks.
- Nimble learning
- Organizational savvy
- Persuades
- Plans and aligns.
- Being resilient
- Resourcefulness
- Drives results
- Demonstrates self-awareness.
- Self-development
- Situational adaptability
- Balances stakeholders
- Strategic mindset
- Builds effective teams.
- Tech savvy
- Instils trust.
- Drives vision and purpose
- Optimizes work processes
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Education and Experience:
The following requirements are essential:
- Matric
- 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 advantageous:
- 1 – 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
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