PURPOSE:
Responsible for accurate capture of inpatient undertakings, authorization, cost control and hospital length of stay management.
PRIMARY RESPONSIBILITIES:
Facilitating admissions and discharges of insured members as per policy.
Conduct hospital visits
Manage cost and average length of stay while the patients are in hospital to ensure prudent utilization.
Pre-authorize treatment for outpatient/inpatient cases as per the policy guidelines
Timely respond to all queries from insured client, service providers and respective contact person on cases involving medical care management.
Maintain a good relationship with partners such as intermediaries at care management level.
Update the relevant stakeholders on the case management update
Coordination and facilitation of both road and air evacuation as per policy.
Seamless Coordinating of overseas treatment from admission to discharge.
Compile relevant reports within the scope of care management as per stipulated guidelines
Receive and respond to Medical emergency lines on a 24-hour basis to ensure adequate coverage of the call Centre
Negotiate for discounts from doctors and service providers on specific cases and procedures as they arise.
Academic and Professional Requirements
Education
Bachelor’s degree in Nursing or clinical Medicine. E
Computer literate in MS Office and other office applications E
Medical Insurance experience in a medical call centre is an added advantage D
Experience Required:
Relevant experience in busy health environment 3
Apply via :
cic.co.ke
