Oncology Case Manager Sabmas

3 weeks ago

Pretoria, Gauteng, South Africa 3SixtyHealth (Pty) Ltd Full time
Oncology Case Manager

POSITION
Managed Healthcare

DIVISION
The role is to ensure provision of holistic treatment of the Oncology patient including out of hospital management of

Oncology. You will be expected to liaise with Oncology treating doctors by acting as a source of information, in relation to
JOB the scheme protocols. Promotion of rational utilization of Oncology benefits without compromising the quality health
PURPOSE delivery to the member. The incumbent will be reporting to the MHC Clinical Operations Manager.

Head Office, Houghton, Gauteng

LOCATION

DUTIES AND RESPONSIBILITIES

  • Plans, develops, assesses, and evaluates care provided to members. Develops and maintains case management policies and proced ures.
Coordinates, directs, and performs concurrent and retrospective reviews, and monitors level and quality of care.

  • Coordinates the interdisciplinary approach to providing continuity of care, including utilization management, transfer coordination, discharge planning
  • Consults with Medical Advisor and external Physicians, health care providers regarding continued care/treatment or hospitaliz ation.
  • Identifies and recommends opportunities for cost savings and improving the quality of care across the continuum.
  • Develops and collects data, and trends utilization of health care resources.
  • Accurately documents the completion of procedures and the patient's responses.
  • Maintains professional ethics and conduct with patients providers and families
  • Demonstration of knowledge and skills necessary to provide care appropriate to the needs of patients served in the assigned a rea of practice
  • Accurately verify and validate providers' orders
  • Safely implement all treatments/procedures and accurately
  • Document the completion of treatments/procedures along with the patient's response
  • Ensure adherence to Scheme Rules
  • Effective handling of Internal/External Clinical Queries Communicate with patients and service providers in order to oncology treatment requests
  • Assist with Health Risk Management Monitoring & Management
  • Carrying out Clinical coding in accordance with requirements and guidelines
  • Compile and submit detailed reports when required

QUALIFICATIONS

  • Registered Nurse (with SANC) with Oncology Diploma or Degree
  • At least 3 to 5 years' experience in Oncology Nursing/Managed care environment/ in the Private Sector essential
  • Clinical knowledge and experience with regard to Oncology
  • Case management experience
  • Sound knowledge of the Medical Schemes Act
  • Sound knowledge of Prescribed Minimum Benefits.
  • Good planning and prioritising abilities
  • Good analytical and problemsolving capabilities
  • Good computer skills (MS Word, MS excel and administration systems)
  • Excellent communication skills, both verbal and written Code 8 drivers license an advantage

PERSONAL ATTRIBUTES

  • Works willingly and effectively with others in and across the organization to accomplish team goals.
  • Knowledge and understanding of the fundamental processes of business, their interaction and the impact of external/internal influences on decision making, growth and decline.
  • Demonstrated strategic thinking and planning and change management skills. High level of energy, drive and enthusiasm.
  • Flexible
  • Excellent interpersonal and networking skills.
  • Able to build and manage complex relationships.
  • Strong analytic skills and knowledge of health care industry with ability to provide solutions to meet client needs and maximize value of deliverables.

Job Type:
Permanent

Ability to commute/relocate:

  • Gauteng, Gauteng: Reliably commute or planning to relocate before starting work (required)

Application Question(s):

  • Are you a Registered Nurse (with SANC) with Oncology Diploma or Degree

Education:

  • Diploma (required)

Experience:

  • Oncology Nursing/
Managed Health Care: 3 years (required)

Application Deadline: 2023/01/14

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