Oncology & Disease Risk Case Manager

Mvgrecruitment; Pretoria; On-site; ZAR 540,000 - 750,000; Full time

Job summary

Mvgrecruitment is seeking an Oncology & Disease Risk Case Manager to join our Managed Care team. The role involves handling oncology pre-authorisations, case management, and disease risk monitoring to ensure adherence to clinical protocols and scheme rules.

The ideal candidate is a Registered Nurse with 2+ years in managed care; 4+ years in medical scheme administration; and strong ICD-10 knowledge. Excellent communication and analytical skills are essential for driving improved patient outcomes.

Qualifications

• Registered Nursing qualification is essential.
• Postgraduate qualification in Intensive Nursing Science or Operating Theatre Technique is advantageous.
• Minimum 2 years of managed care experience, oncology exposure preferred.
• 4+ years of medical scheme administration experience.
• Strong knowledge of ICD-10 coding and medical aid industry rules.
• Excellent communication, analytical and people management skills.

Responsibilities

• Manage oncology pre-authorisations, case management, and disease risk monitoring.
• Ensure adherence to scheme rules, benefits, and clinical protocols.
• Handle internal and external clinical queries with members and providers.
• Analyse patient history, reports, and clinical results to develop cost-effective treatment plans.
• Refer high-cost drugs and appeals to medical advisors for final decisions.
• Negotiate discounts with providers and propose benefit design improvements.
• Provide training and guidance to clinical consultants on oncology treatment and benefits.

Skills

Communication

Analytical thinking

People management

Oncology knowledge

Education

Registered Nursing qualification

Postgraduate in Intensive Nursing Science

Operating Theatre Technique

Tools

ICD-10 coding

Job description

Oncology & Disease Risk Case Manager - We are seeking a skilled healthcare professional to join our Managed Care team as an Oncology & Disease Case Manager.

Key Responsibilities:

• Manage oncology pre-authorisations, case management, and disease risk monitoring.
• Ensure adherence to scheme rules, benefits, and clinical protocols.
• Handle internal and external clinical queries with members and providers.
• Analyse patient history, reports, and clinical results to develop cost-effective treatment plans.
• Refer high-cost drugs and appeals to medical advisors for final decisions.
• Negotiate discounts with providers and propose benefit design improvements.
• Provide training and guidance to clinical consultants on oncology treatment and benefits.

Requirements:

• Registered Nursing qualification (essential).
• Postgraduate qualification in Intensive Nursing Science or Operating Theatre Technique advantageous.
• Minimum 2 years’ managed care experience, with oncology exposure preferred.
• 4+ years’ medical scheme administration experience.
• Strong knowledge of ICD-10 coding, medical aid industry rules, and legislation.
• Excellent communication, analytical, and people management skills.

What is on Offer: An opportunity to contribute to innovative oncology case management, and play a critical role in improving patient outcomes while managing healthcare risk effectively.