About the Role

Job Ref. No. JHIL050

Role Purpose

Care Management, visiting patients at the various service providers, providing professional guidance on policy matters where requested, ensuring comfort and assistance of patient by the service provider, and communicating with providers, clients and brokers on a timely basis for any rejections or relevant concerns

Main Responsibilities

• Obtaining daily reports of admissions in the various service providers.
• Broker/customer communications by communicating as necessary admission claim decisions on a timely basis.
• Care Management - Through due diligence, ensuring undertakings are issued in line with the policy provisions. Likewise for declines, ensuring that the decisions are accurate.
• Visiting of patients at the various service providers, obtaining details of patients to confirm that admitted members are the eligible policy holders/ dependents.
• Confirming that the treatment the member is given is covered by the policy purchased.
• Ensuring that the medical reports in the hospital are accurate and reflective of what is provided to the insurer and confirm what the member understands or communicates.
• Ensuring proper care and treatment of patient within acceptable protocols without wastage by member/ provider.
• Reviewing medical pre-authorizations for compliance with applicable policy guidelines and giving guidance to the other care management team on any information collected during the visits to the hospitals.
• Interacting with clients, brokers and clinicians as needed, to resolve problems in a manner that is legal, ethical, and consistent with the principles of the policy.
• Obtaining medical information from providers with written correspondence if necessary.
• Participating in care management meetings

Functional Skills

• Performance reporting and management
• Health Benefits Plan Management
• Intelligence and Business Development skills
• Policy Interpretation
• Customer Service

Key Competencies

• Visionary Leadership
• Market Awareness
• Customer Focus
• Continuous Innovation
• Ownership & Commitment
• Team Spirit

Qualifications

• Degree/ Diploma holders preferably in clinical studies (nursing, clinical medicine)
• Basic understanding of the concepts of insurance
• Proficient in the use of Microsoft office suite and packages.

How to Apply

If you are qualified and seeking an exciting new challenge, please apply via [email protected] quoting the Job Reference Number and Position