Anita Devnarain
Hospital Benefit Specialist
Reservoir Hills,KZN
Summary
Experienced Hospital Benefit Specialist and In-Hospital Case Manager with strong clinical and risk management expertise. Proven ability to manage complex admissions, funding decisions, and cost containment strategies. Skilled in stakeholder engagement, case escalations, and process improvement. Holds a Bachelor of Commerce Honours degree.
Overview
1
1
Language
12
12
years of professional experience
Work History
Hospital Benefit specialist (HBS)
Discovery Care
12.2020 - Current
- Targeted cost per event challenges, length of stay, length of admission, and avoidable returns to hospital through guided discharge planning process in onsite ward case management.
- On-site Risk Management with more rigor to prevent unwarranted extended stay in acute hospitals, higher level of acuity as well as avoidable return- to -acute admissions within 30 days
- Evaluated and provided input on funding decisions for level of care requests.
- Assisted in resolving complex benefits issues, leading to increased employee satisfaction and retention rates.
- Developed relationships with providers to improve quality of service delivery.
In Hospital Case Manager (skilled in all pools)
Discovery Care
06.2019 - 11.2020
- Managed in-hospital admissions using clinical information and knowledge to determine appropriate level of care and length of stay, ensuring adherence to protocols and guidelines.
- Assisted Covid IHCM team with data management tasks.
In Hospital CRM (skilled in all pools)
Discovery Care
05.2017 - 05.2019
- To update in hospital authorizations with clinical information, warrant level of care and length of stay. To risk manage events holistically.
- Ensured members were informed of financial implications during admissions.
- Skilled in all network query pools, PQ and Retro
- Specialized pool Tavi and Davinci
- Reviewing and applying criteria for funding
- Discussing cost implications and payment agreements with facility, Dr and members
- To ensure members are advised on any financial implications on and during admissions.
- Coordinated event loading and managed patient care comprehensively until discharge.
- Collaborated with Risk team on new procedures involving Tavi and Davinci.
Pre-authorisations consultant (Discovery health and In House)
Discovery Health Medical Aid
05.2014 - 12.2014
- Reviewed and approved hospital event admissions to ensure compliance with protocols.
- To maintain the risk of the company/ by ensuring appropriate services are provided, and correct protocols and funding are applied
Enrolled nurse
St Augustine’s Hospital
01.2014 - 04.2014
- Provided nursing care across ward, administered medication, monitored patients holistically, and coordinated handovers to OT/ICU/HC during doctor rounds.
Education
Certificate - Enrolled Nursing
Netcare Education
Bachelor of Commerce - Risk management, Health management
Regent Business School
2023
Bachelors of Commerce Honours - Healthcare Management
Regent Business School
04.2001 -
Skills
Clinical Risk Assessment & Cost ContainmentAbility to evaluate level of care, length of stay, and treatments while managing financial risk
Funding Decision & Benefits ApplicationSkilled in interpreting scheme rules and making accurate funding decisions for procedures, medication, and admissions
Complex Case ManagementProven ability to manage high-risk and specialised cases (including TAVI, Da Vinci, PQ, Retro) from admission to discharge
Stakeholder Engagement & CommunicationStrong communication with members, doctors, and hospital teams to facilitate effective outcomes
Escalation Handling & Problem ResolutionExperience in managing escalations, analysing complex cases, and driving resolution
Training, Coaching & Quality AuditingAbility to train new staff, audit cases, and provide coaching to improve compliance and performance
Timeline
Hospital Benefit specialist (HBS)
Discovery Care
12.2020 - Current
In Hospital Case Manager (skilled in all pools)
Discovery Care
06.2019 - 11.2020
In Hospital CRM (skilled in all pools)
Discovery Care
05.2017 - 05.2019
Pre-authorisations consultant (Discovery health and In House)
Discovery Health Medical Aid
05.2014 - 12.2014
Enrolled nurse
St Augustine’s Hospital
01.2014 - 04.2014
Bachelors of Commerce Honours - Healthcare Management
Regent Business School
04.2001 -
Certificate - Enrolled Nursing
Netcare Education
Bachelor of Commerce - Risk management, Health management
Regent Business School
Drivers Licence
Code 10