Hospital Benefit & Care Navigator

Discovery Limited; Cape Town; On-site; ZAR 380,000 - 560,000; Full time

Job summary

Discovery Health in Cape Town is seeking a Hospital Benefit Specialist to assess members' clinical history, determine appropriate levels of care, and manage benefits within the Chronic and PMB management framework.

The role requires coordinating discharge planning, communicating decisions to providers and patients, and handling escalations while contributing to trend analyses and process improvements within Discovery Care.

Qualifications

• Must be a Registered Nurse with valid SANC registration.
• Minimum 3 years clinical experience in a private hospital setting (ICU, trauma/casualty, medical/general ward preferred).
• 2 years managed health care experience.
• Microsoft Office, specifically Excel experience.

Responsibilities

• Assess cases based on clinical history, coding, level of care and facility appropriateness.
• Communicate funding decisions and information to providers and members.
• Coordinate discharge planning and alternatives to hospital care.
• Engage with hospital staff, Patient Services Manager and providers for escalations.
• Provide trend analysis and propose improvements to care processes.

Skills

Excel

Education

Registered Nurse

SANC Registration

Matric

Tools

MS Office

Job description

Discovery Health in Cape Town is seeking a Hospital Benefit Specialist to assess members' clinical history, determine appropriate levels of care, and manage benefits within the Chronic and PMB management framework.

The role requires coordinating discharge planning, communicating decisions to providers and patients, and handling escalations while contributing to trend analyses and process improvements within Discovery Care.