Oncology Case Manager

2 months ago


Sandton, South Africa Discovery Ltd. Full time

**Business Unit**:Discovery Health**Function**:Client Service**Date**:10 Sep 2024**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.

**Key Purpose**:
**Key Outputs**:
The successful applicant will be responsible for but not limited to the following job functions:

- Enroll Member on Oncology Program and ensure that the member meets all requirements to qualify for the benefit (i.e. Forensics, Underwriting categories)
- Review treatment plans in line with the SAOC and Icon guidelines
- Approve treatment in line with SAOC/Icon as well as Discovery Health protocol.
- Decline treatment which is not in line with SAOC\ICON as well as internal Discovery Health protocol.
- Refer complex cases to internal and external Medical Review teams and provide feedback to both members and Providers.
- Communicate funding decisions to members, employers and brokers verbally or in writing.
- Make comprehensive notes on treatment that was approved/declined and how the funding decision was made.
- Mitigate risk by using clinical knowledge to identify risk and reporting it accordingly.
- Provide support to members, CHO Service Agents, Doctors and Pharmacist.
- Support to Doctors by coordinating treatment plans and sending them updated guidelines and information.
- Meeting daily Operational targets.

**Competencies**:
**Role Specific Behaviours**
- Ensures accountability.
- Action oriented
- Manages ambiguity.
- Attracts top talent.
- Business insight
- Collaborates
- Communicates effectively.
- Manages complexity.
- Manages conflict.
- Courage
- Customer focus
- Decision quality
- Develops talent
- Values differences
- Directs work.
- Drives engagement
- Financial acumen
- Global perspective
- Cultivates innovation.
- Interpersonal savvy
- Builds networks.
- Nimble learning
- Organizational savvy
- Persuades
- Plans and aligns.
- Being resilient
- Resourcefulness
- Drives results
- Demonstrates self-awareness.
- Self-development
- Situational adaptability
- Balances stakeholders
- Strategic mindset
- Builds effective teams.
- Tech savvy
- Instils trust.
- Drives vision and purpose
- Optimizes work processes

**Education and Experience**:
The following requirements are essential:

- Matric
- Registered & Enrolled Nurse
- Registered with SANC
- 2 years Clinical experience
- Microsoft Office
- Effective communication skills (verbal & written)
- Effective presentation skills
- Telephone Etiquette
- Active listening skills

The following requirements will be advantageous:

- Knowledge of Oncology Treatment Interventions.
- 1-year experience as a Case Manager.
- DH systems and products.

**Personal Attributes or Competency Profile**

The Discovery Person
- Values Driven
- Optimistic
- Learns on the Fly
- Resilient
- Instils Trust
- People Savvy
- Drives Results
- Problem Solver
- 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.



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