Job Description: 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. Job Responsibilities: Approve treatment in line with SAOC/ICON as well as Discovery Health protocol. Enroll Member on Oncology Program and ensure that the member meets all requirements to qualify for the benefit (i.e. Forensics, Underwriting categories) 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. Review treatment plans in line with the SAOC and ICON guidelines 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. Job Requirements: Matric Effective presentation skills Registered & Enrolled Nurse Effective communication skills (verbal & written) Registered with SANC Experience in Oncology Treatment Interventions. Microsoft Office 2 years Clinical experience
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