Overall Purpose of the Job
Reporting
to the Supervisor Case Management, the Care Manager will ensure quality and
efficiency in case management as well provide quality medical service delivery
to all our clients.
Key Responsibilities
- Handling the emergency office lines and
responding to clients queries as they arise on a 24/7 basis.
- Negotiate rates and treatment protocols
with providers with a view to keeping claims below 60%.
- Implement all care management protocols
and ensure that all procedures of the company are adhered to in
adjudication resulting in accurate medical assessment, interpretation and
intervention.
- Manage the workflow process from
pre-authorization, case management and necessary system updates for claim
processing.
- Implement and oversee the pre-existing
& chronic disease management program, follow up of clients after
discharge from hospital with a view of cost management for the company and
the clients.
- Daily follow-up (Calling/Visits) of all
hospitalized clients, to provide advice on coverage and care, manage end
to end admission and discharge process of all clients.
- Prepare daily case management reports on
admissions with detailed analysis for discussion and planning with action
that favor the company as per the scheme rules and guidelines.
- Report on all admissions and issue
relevant communication/letters for approved cases to all parties
involved.
- Monitor cost of treatment at the various
providers and advise underwriting department, and management on the most
cost-effective providers to use.
- Communicate in a timely manner all
rejections, deductions or declines to service providers and members with
documentary evidence of the same.
- Clients presentations and member
education on wise benefits utilization & risk management.
- Liaising with our underwriting section on
scope of cover for various schemes.
Education, Experience & Competencies
- Holder of a Bachelor’s degree preferably
in Nursing or Clinical Medicine.
- Possess at least 5 years relevant
experience.
- Demonstrate a good understanding of case
management.
- Proficient in the use of Microsoft office
suite and packages.
- High level of Emotional
Intelligence.
- Excellent Communication and Interpersonal
skills.
- Customer focused with strong problem
solving skills
- Professional Insurance Certification (COP
or Diploma in Insurance) is an added advantage
- Good interpersonal skills and a team
player
Why Join Us:
- A dynamic and supportive work
environment.
- Opportunities for professional growth and
career advancement.
- Competitive salary and benefits package.
- Being part of a leading insurance company
committed to innovation and excellence.
How To Apply
