Office jobs in South Africa

Business Unit: Discovery Health

Function: Case Management

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.

About Discovery Care

Discovery Care, a subsidiary of Discovery Health, comprises of several specialized clinical areas with segmented teams. The Chronic and PMB Management team handles the 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. Additionally, the Hospital Benefit Specialists, as part of field force, are responsible for real‑time risk management and the Care Coordination Services manages the Managed Care programs.

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.

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.

The successful candidate must demonstrate the following competencies:

Role Specific Behaviours

☒ Action oriented

☐ Attracts top talent.

☒ Business insight

☐ Directs work.

☐ Global perspective

☒ Cultivates innovation.

☒ Interpersonal savvy

☒ Nimble learning

☒ Organizational savvy

☒ Plans and aligns.

☐ Drives results

☒ Situational adaptability

☐ Balances stakeholders

☐ Strategic mindset

☐ 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
• Knowledge of Oncology Treatment Interventions
• Microsoft Office

The following requirements will be advantageous:

• 1-year experience as a Case Manager.
• DH systems and products.

Personal Attributes or Competency Profile

The Discovery Person

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

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.