Clinical Care Specialist

Clinical Care Specialist

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 Care

Discovery Care, a subsidiary of Discovery Health, comprises of several specialized clinical areas with segmented teams. The Chronic and PMB Management team handles the processing of Chronic and Prescribed Minimum Benefit requests and manages escalated clinical queries. The HIV/Oncology and In-Hospital Case Management teams review clinical cases specific to their areas of expertise. The High Touch team provides hands-on services and resolves escalated queries for sensitive cases. Additionally, the Hospital Benefit Specialists, as part of field force, are responsible for real-time risk management and the Care Coordination Services manages the Managed Care programs.

Key Purpose:

To holistically review the needs of clinically complex members and coordinate their care in the most appropriate setting, liaising with internal and external stakeholders to ensure the best clinical outcomes.

Key Outputs

·       Perform health assessments on patients in order to identify individual patient risk factors

·       Perform interventions to influence individual patient risk

·       Promote behavior change to ensure greater treatment compliance and condition management

·       Authorising of admissions and treatment as per agreed protocols

·       Assist members with clinical related queries

·       Proactively assist complex member with understanding their plan benefits and maximizing their use to effect risk savings in the long term

·       Monitor patient progress through ongoing patient interaction and follow-up.

·       Co-ordination of integration of care including social services where appropriate.

·       Maintain relationships between key internal and external stakeholders

·       Refer to other departments where appropriate to ensure that the relevant benefits are provided

Competencies:

The successful candidate must demonstrate the following competencies:

Education and Experience:

The following requirements are essential:

·       Matric

·       Registered Nurse qualification

·       Valid SANC registration

·       MS Office

·       At least 3 years clinical nursing experience, post training.

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The following requirements will be advantageous:

·       Managed care experience

·       Discovery Health system knowledge and experience

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.