Case Manager Specialist - Oncology at Discovery Limited

Key Purpose:

• This position requires the successful candidate to work in Specialized Oncology workflow pools and secondary to work in other Oncology workflow pools, to ensure that all clinical cases are reviewed, and relevant decisions made.

Key Outputs:

The successful applicant will be responsible for but not limited to the following job functions:

• To work in the Specialized Oncology workflow pools
• To work in other Oncology workflow pools when the need arises.
• To make concise clinical decisions according to the Oncology guidelines and processes
• Preparing of cases, case presentation, Loading member remarks and clinical exceptions. Communication regarding decision to relevant parties.
• Knowledge of claims, coding and assisting in getting payment resolution
• Request and review ICD /procedure codes, photographs, motivation letters and further supporting documentation as required
• Knowledge of Prescribed Minimum benefit in order to resolve related queries.
• Escalating cases/queries that cannot be resolved to Medical Advisors
• Telephonic and written communication with doctors, providers, members (inbound/outbound)
• Understanding of IQS and compliancy in ensuring IQS objectives are met
• Knowledge of claims, coding and assisting in getting payment resolutions 

Competencies:

The successful candidate must demonstrate the following competencies:

Role Specific Behaviours

• Ensures accountability.
• Action oriented
• Manages ambiguity.
• Attracts top talent.
• Business insight
• Collaborates
• Communicates effectively.
• Manages complexity.
• Manages conflict.
• Courage
• Customer focus
• Decision quality
• Develops talent
• Values differences
• Directs work.
• Drives engagement
• Financial acumen
• Global perspective
• Cultivates innovation.
• Interpersonal savvy
• Builds networks.
• Nimble learning
• Organizational savvy
• Persuades
• Plans and aligns.
• Being resilient
• Resourcefulness
• Drives results
• Demonstrates self-awareness.
• Self-development
• Situational adaptability
• Balances stakeholders
• Strategic mindset
• Builds effective teams.
• Tech savvy
• Instils trust.
• Drives vision and purpose
• Optimizes work processes

Education and Experience:

The following requirements are essential:

• Matric
• Relevant Clinical Qualification: Registered Nurse or Enrolled Nurse
• Relevant, 2 years clinical experience
• Valid professional registration with SANC
• 2 years Oncology Senior Case management experience

Personal Attributes or Competency Profile

The Discovery Person

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

Key Purpose:

• This position requires the successful candidate to work in Specialized Oncology workflow pools and secondary to work in other Oncology workflow pools, to ensure that all clinical cases are reviewed, and relevant decisions made.

Key Outputs:

The successful applicant will be responsible for but not limited to the following job functions:

• To work in the Specialized Oncology workflow pools
• To work in other Oncology workflow pools when the need arises.
• To make concise clinical decisions according to the Oncology guidelines and processes
• Preparing of cases, case presentation, Loading member remarks and clinical exceptions. Communication regarding decision to relevant parties.
• Knowledge of claims, coding and assisting in getting payment resolution
• Request and review ICD /procedure codes, photographs, motivation letters and further supporting documentation as required
• Knowledge of Prescribed Minimum benefit in order to resolve related queries.
• Escalating cases/queries that cannot be resolved to Medical Advisors
• Telephonic and written communication with doctors, providers, members (inbound/outbound)
• Understanding of IQS and compliancy in ensuring IQS objectives are met
• Knowledge of claims, coding and assisting in getting payment resolutions  

Competencies:

The successful candidate must demonstrate the following competencies:

Role Specific Behaviours

• Ensures accountability.
• Action oriented
• Manages ambiguity.
• Attracts top talent.
• Business insight
• Collaborates
• Communicates effectively.
• Manages complexity.
• Manages conflict.
• Courage
• Customer focus
• Decision quality
• Develops talent
• Values differences
• Directs work.
• Drives engagement
• Financial acumen
• Global perspective
• Cultivates innovation.
• Interpersonal savvy
• Builds networks.
• Nimble learning
• Organizational savvy
• Persuades
• Plans and aligns.
• Being resilient
• Resourcefulness
• Drives results
• Demonstrates self-awareness.
• Self-development
• Situational adaptability
• Balances stakeholders
• Strategic mindset
• Builds effective teams.
• Tech savvy
• Instils trust.
• Drives vision and purpose
• Optimizes work processes

Education and Experience:

The following requirements are essential:

• Matric
• Relevant Clinical Qualification: Registered Nurse or Enrolled Nurse
• Relevant, 2 years clinical experience
• Valid professional registration with SANC
• 2 years Oncology Senior Case management experience

Personal Attributes or Competency Profile

The Discovery Person

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