Case Manager - Oncology (Durban And Sandton) )

Discovery Limited; Gauteng; On-site; ZAR 35 000 - 60 000; Full time

Job summary

An established industry player is seeking a dedicated Case Manager for Oncology to enhance patient care through effective management of treatment plans. This role involves enrolling members, ensuring compliance with clinical guidelines, and providing essential support to patients and healthcare providers. The ideal candidate will possess strong clinical knowledge, excellent communication skills, and a commitment to delivering high-quality healthcare services. Join a dynamic team where your contributions will directly impact the well-being of patients and their families, fostering a healthier society.

Qualifications

• 2 years clinical experience required.
• Knowledge of Oncology treatment interventions is advantageous.

Responsibilities

• Manage enrolled Oncology members and review treatment plans.
• Approve or decline treatment based on guidelines.

Skills

Clinical Knowledge

Active Listening

Communication

Problem Solving

Collaboration

Education

Matric

Registered & Enrolled Nurse

Registered with SANC

Tools

Microsoft Office

Job description

Case Manager Oncology

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 to achieve financial success and to ignite positive and meaningful change within society.

About Discovery Care

Discovery Care, a subsidiary of Discovery Health, comprises several specialized clinical areas with segmented teams, including:

• The Chronic and PMB Management team handles processing of Chronic and Prescribed Minimum Benefit requests and manages escalated clinical queries.
• The HIV / Oncology and In-Hospital Case Management teams review clinical cases specific to their areas of expertise.
• The High Touch team provides hands-on services and resolves escalated queries for sensitive cases.
• The Hospital Benefit Specialists, part of the field force, are responsible for real-time risk management, and the Care Coordination Services manage the Managed Care programs.

Key Purpose

Manage enrolled Oncology members by reviewing the clinical appropriateness of prescribed treatment, ensuring correct application of Clinical Entry Criteria, Protocols, SOPs, and Clinical guidelines. Explain benefits to members and provide counseling.

Key Outputs

• Enroll members in the Oncology Program and verify they meet all requirements for the benefit (e.g., Forensics, Underwriting categories).
• Review treatment plans in line with SAOC and Icon guidelines.
• Approve treatment aligned with SAOC / Icon and Discovery Health protocols.
• Decline treatment not in line with guidelines and protocols.
• Refer complex cases to Medical Review teams and communicate decisions to members and providers.
• Document funding decisions and treatment details comprehensively.
• Use clinical knowledge to identify and report risks.
• Support members, service agents, doctors, and pharmacists with coordination and information sharing.
• Meet daily operational targets.

Competencies

The successful candidate must demonstrate competencies such as accountability, action orientation, managing ambiguity, talent attraction, business insight, collaboration, effective communication, managing complexity and conflict, courage, customer focus, decision quality, talent development, valuing differences, work direction, engagement, financial acumen, global perspective, innovation, interpersonal savvy, networking, learning agility, organizational savvy, persuasion, planning, resilience, resourcefulness, results-driven, self-awareness, self-development, adaptability, stakeholder management, strategic mindset, team building, tech savviness, trust-building, vision and purpose drive, and process optimization.

Education and Experience

• Matric
• Registered & Enrolled Nurse
• Registered with SANC
• 2 years clinical experience
• Proficiency in Microsoft Office
• Active listening skills

Additional advantageous requirements include knowledge of Oncology treatment interventions, 1-year experience as a Case Manager, and familiarity with DH systems and products.

Personal Attributes

Values-driven, optimistic, quick learner, resilient, trustworthy, people-savvy, results-oriented, problem solver.

Employment Equity & Diversity

Discovery considers its Employment Equity Plan and Targets during recruitment and encourages applications from people with disabilities, as an Equal Opportunities employer.