PURPOSE:
Responsible for accurate capture of inpatient undertakings, authorization, cost control and hospital length of stay management.
PRIMARY RESPONSIBILITIES:
Review and provide clinical and financial guidance on Outpatient /Dental/Optical and inpatient approval request
24-hour Call Centre coverage as per allocated shifts.
Give financial undertaking on eligible cases with reference to the policy guide lines and benefits limits.
Ensure the hospitals /doctors adhere to CIC admission procedures/cost guidelines
Identify cases for potential risks /long stay or complex and notify the relevant stake holders in good time.
Customer engagement through hospital visits and calls for all admitted patients to monitor progress clinically/financially and prepare daily feedback reports.
Evaluate and facilitate referral cases and scheduled surgeries promptly once pre-authorization request have been received.
Assess all bills during admission and on discharge to ensure treatment is consistent with illness declared and cost for items are also in line with the market rate/CIC rates.
Promptly request for medical/progress report where applicable, review and make clinical decisions in line with CIC policy.
Monitor benefits utilization and where necessary communicate to the contact person of scheme.
Daily follow up on the progress of all admitted patients with doctors to evaluate progress, promote continuity of care and ensure improved health outcomes.
Daily updates on patient condition to the scheme contacts and intermediaries.
Review and prudent decision making on all overseas referrals
Claims analysis and clinical recommendations to address health seeking behaviors and ensure cost management while maintaining good outcomes.
Coordinate medical care monthly Rota and duty allocation and ensure comprehensive coverage of all shifts
Timely preparation and submission of Care Management reports
Other Duties
Carry out performance appraisal, coaching and mentoring staff;
Participate in planning and budgeting for the department.
PERSON SPECIFICATIONS
Academic Qualifications
Minimum of a Bachelor’s degree in Nursing (KRCHN).
Health System Management is an added advantage.
Experience
Up to three (3) years’ relevant experience in care management role/call Centre Management.
Supervisory experience will be an added advantage.
Professional Qualifications
Registration with the Nursing Council of Kenya
Skills and Attributes
Problem solving skills;
Good analytical skills;
Computer literate in MS Office and other office applications;
Understanding of the working environment /competitors;
Technical competence in Health Care insurance;
Basic knowledge of regulations by AKI and IRA;
High emotional intelligence;
If you have the aforementioned professional and academic qualifications and you are ready to execute the above mandate.
Strictly apply through https://cic.co.ke/job-application/ clearly indicating The Position being applied for. E.g. CARE SERVICE MANAGEMENT OFFICERThe application should reach us by close of business on 26th February, 2021. Please note only short listed candidates will be contacted. If you do not hear from us by 12th March, 2021 consider your application unsuccessful.
Apply via :
cic.co.ke
