Key Purpose:<\/p>\n
The successful applicant will be responsible for but not limited to the following job functions:<\/p>\n
Assessing the case in relation to the following:<\/p>\n
\tMembers clinical history
\n\tMembers benefit structure
\n\tClinical Information and coding supplied
\n\tLevel of care provided
\n\tAppropriateness of the facility
\n\tAppropriateness of the treating doctor
\n\tAppropriateness of treatment
\n\tManaging 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
\n\tDischarge planning by providing the member with alternatives to receive treatment (This includes Hospital @ Home, Homecare etc.)<\/p>\n
Effective and accurate communication to all stakeholders:<\/p>\n
\tCase update to the provider
\n\tFunding decisions and benefit confirmation to the members
\n\tRequest for additional information from the treating doctor or practice manager
\n\tEngaging with Patient Services Manager and hospital staff
\n\tHandling escalations from Providers and internal stakeholders
\n\tPreparing and presenting complex case to clinical review
\n\tTrend Analysis of inefficiencies and proposals to correct
\n\tAppropriate internal case referrals for clinical management<\/p>\n
Operational Targets:<\/p>\n
\tAttend to patients on daily report
\n\tReview all low acuity admission requests
\n\tQuality of processes<\/p>\n
\u00a0Education and Experience:<\/p>\n
The following requirements are essential:<\/p>\n
\tMatric
\n\tMust be a Registered Nurse
\n\tValid SANC Registration
\n\t3 years Clinical experience in a private hospital setting (ICU, Trauma\/Casualty, Medical\/General ward preferable)
\n\t2 years Managed health care experience\u00a0
\n\tMicrosoft Office (Specifically Excel experience)
\n\tValid Driver\u2019s License and own transport ( working hours are between 08:30 -17:00 & travel up to 50KM may be required)
\n\tEffective Communication Skills (Verbal & Written)
\n\tTelephone Etiquette
\n\tActive Listening Skills<\/p>\n
The following requirements are advantageous:<\/p>\n
\t1 \u2013 2 years ICU experience
\n\tKnowledge of DH SOP\u2019s and Process experience (internal only)
\n\tProvider payment arrangements (internal Only)
\n\tClinical coding knowledge of ICD-10 and\/or CCSA<\/p>\n
go to method of application \u00bb<\/p>\n
Apply via company website ( ) or<\/p>\n
<\/p>\n","protected":false},"author":2,"featured_media":0,"template":"","meta":{"_promoted":"","_job_location":"","_application":"","_company_name":"Discovery Limited","_company_website":"","_company_tagline":"","_company_twitter":"","_company_video":"","_filled":0,"_featured":0,"_remote_position":0,"_job_salary":"","_job_salary_currency":"","_job_salary_unit":""},"job_listing_region":[16],"job-types":[12],"class_list":{"0":"post-37634","1":"job_listing","2":"type-job_listing","3":"status-publish","4":"hentry","5":"job_listing_region-kwazulu-natal","7":"job-type-full-time"},"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/jobs.dataaxisnode.com\/southafrica\/wp-json\/wp\/v2\/job-listings\/37634","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/jobs.dataaxisnode.com\/southafrica\/wp-json\/wp\/v2\/job-listings"}],"about":[{"href":"https:\/\/jobs.dataaxisnode.com\/southafrica\/wp-json\/wp\/v2\/types\/job_listing"}],"author":[{"embeddable":true,"href":"https:\/\/jobs.dataaxisnode.com\/southafrica\/wp-json\/wp\/v2\/users\/2"}],"wp:attachment":[{"href":"https:\/\/jobs.dataaxisnode.com\/southafrica\/wp-json\/wp\/v2\/media?parent=37634"}],"wp:term":[{"taxonomy":"job_listing_region","embeddable":true,"href":"https:\/\/jobs.dataaxisnode.com\/southafrica\/wp-json\/wp\/v2\/job_listing_region?post=37634"},{"taxonomy":"job_listing_type","embeddable":true,"href":"https:\/\/jobs.dataaxisnode.com\/southafrica\/wp-json\/wp\/v2\/job-types?post=37634"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}