Oncology Case Manager

2 weeks ago

Johannesburg, South Africa 3Sixty Health (Pty) Ltd Full time

3Sixty Health has a great opportunity for a suitably qualified individual to fulfil the advertised position and join their team.

3Sixty Health is a black owned and managed, reputable and a major player in driving South African economy by investing

**3SIXTY HEALTH **in ‘’black excellence’’3Sixty Health is 100% black owned and black managed administrator. It is accredited by the council

**BACKGROUND **for medical schemes to offer both administration and managed care services, allowing for a fully integrated, beneficiary
- centric approach. Our core competencies in administration include membership management, billing, claim adjudication and customer services.

It is a medical aid administrator of Sizwe Hosmed Medical Scheme.

**POSITION **Oncology Case Manager

**DIVISION **Managed Healthcare

Your 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
**JOB PURPOSE ** to the scheme protocols. Promotion of rational utilization of Oncology benefits without compromising the quality health delivery to the member. The incumbent will be reporting to the MHC Clinical Operations Manager.

**LOCATION **Head Office, Houghton, Gauteng

**DUTIES AND RESPONSIBILITIES**
- Plans, develops, assesses, and evaluates care provided to members. Develops and maintains case management policies and procedures.

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 hospitalization.
- 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 area 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
- Sound knowledge of the Medical Schemes Act
- Sound knowledge of Prescribed Minimum Benefits.
- Good planning and prioritising abilities
- Good analytical and problem-solving capabilities
- Good computer skills (MS Word, MS excel)
- Excellent communication skills, both verbal and written
- 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 would be an advantage.
- Code 8 drivers license an advantage

**EXPERIENCE**
- 5-7 years’ experience in Stakeholder management and provider relations preferably with the medical aid industry.
- Previous experience of managing diverse support functions will be an advantage
- Good understanding of ICD-10, CPT and tariff coding
- Good understanding of applicable legislation and PMB conditions
- Knowledge and understanding of legislative frameworks pertaining to Medical Schemes and Managed Healthcare
- Experience in the establishment and/or management of provider networks and IPAs

**KNOWLEDGE**
- Understanding of networking, relationship management, stakeholder strategies, etc.
- Industry knowledge will be an advantage

**SKILLS**
- Relationship Building Skills
- Strong Sales Management Skills
- Negotiation Skills
- Conflict Management Skills
- Cross Functional Skills

**REQUIREMENTS**
- Able to travel
- Valid driver’s license

**Job Type**: Permanent

Application Question(s):

- Good understanding of ICD-10, CPT and tariff coding?

**Education**:

- Bachelors (required)

**Experience**:

- 4years Oncology/Private sector/Managed careector/: 4 years (required)

**Language**:

- English Good communicational skills (required)

Application Deadline: 2024/03/12

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