Case Manager Specialist - Oncology - Talentpool

Case Manager Specialist

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:

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:

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

EMPLOYMENT EQUITY   
                             
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.