Job Description

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.

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.

Key Outputs:

The successful Candidate will be responsible for but not limited to the following Job function:

• 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 SAOCICON 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 internal and external stakeholders
• Guide members and providers through the Oncology benefit by coordinating treatment plans and sending them updated guidelines and information. Maintain up to date knowledge on your professional and clinical skill.
• Meeting daily Operational targets.

Competencies:

The successful candidate must demonstrate the following competencies:

• Analyzing: Analyses numerical data, verbal data, and all other sources of information. Breaks information into component parts, patterns, and relationships. Probes for further information or greater understanding of a problem. Makes rational judgments from the available information and analysis. Produces workable solutions toa range of problems. Demonstrates an understanding of how one issue may be a part of a much larger system.
• Deciding and Initiating Action: Makes prompt, clear decisions, which may involve tough choices or considered risks. Takes responsibility for actions, projects and people. Takes initiative, acts with confidence, and works under own direction. Initiates and generates activity.
• Following Instructions and Procedures: Appropriately follows instructions from others without unnecessarily challenging authority. Follows procedures and policies. Keeps to schedules. Arrives punctually for work and meetings. Demonstrates commitment to the organization. Complies with legal obligations and safety requirements of the role.
• Presenting and Communicating Information: Speaks clearly and fluently. Expresses opinions, information, and key points of an argument clearly. Makes presentations and undertakes public speaking with skill and confidence. Responds quickly to the needs of an audience and to their reactions and feedback. Projects credibility.
• Delivering Results and meeting customer expectations: Focuses on customer needs and satisfaction. Sets high standards for quality and quantity. Monitors and maintains quality and productivity. Works in a systematic, methodical, and orderly way. Consistently achieves project goals.

Education and Experience:

• Matric
• Registered & Enrolled Nurse
• Registered with SANC
• 2 years Clinical experience
• Experience in Oncology Treatment Interventions.
• Microsoft Office
• Effective communication skills (verbal & written)
• Effective presentation skills
• Telephone Etiquette
• Active listening skills

The following requirements will be advantageous:

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

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.

Discovery