Key Purpose:

• Management of enrolled Oncology members by reviewing clinical appropriateness of treatment is prescribed. This involves the correct application of Clinical Entry Criteria, Protocols, SOP’s and Clinical guidelines as well as explaining the benefit to the member and counselling the member.

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 SAOCICON 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:

The successful candidate must demonstrate the following competencies:

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

• Values Driven
• Optimistic
• Learns on the Fly
• Resilient
• Instils Trust
• People Savvy
• Drives Results
• Problem Solver