Job Ref. No: JHIL092
Role Purpose
As the Assistant Manager, Care Navigation, you would be responsible for handling all inpatient and specialized test preauthorization, and communicating with providers, clients, and brokers on a timely basis for any undertakings, rejections, or relevant concerns.
Main Responsibilities
Strategy
Improve business retention by actively engaging the company’s clients in care navigation.
Ensure full utilization of Jubilee Health Insurance’s navigation and wellness programs.
Operational
Ensure navigation Programs using evidence-based guidelines add value, drive clinical performance, improve retention, and reduce disparity.
Implement disease management programs and care coordination through the continuum of care.
Ensure optimal update of case management concurrent review notes.
Ensure implementation of population health strategies that address the utilization, quality, average cost of care, patient satisfaction, and overall marketplace competitiveness.
Regularly develop a database of statistics and narratives for tracking progress and efficacy of treatments and activities for care navigation outcomes and incidence rates.
Ensure high enrollment of members to the Jubilee Mum’s Wellness Club, Chronic disease management program and loyalty program.
Designing and implementing navigation care plans and programs by offering support and tracking progress.
Support call center staff by coordinating navigation, training, and escalation processes regarding the Company Navigation programs.
Participate in member education and training to clients on the various navigation programs in the business.
Ensure care navigation functions realize quality improvement in medical management, improve quality and access to care, reduce claims costs and demonstrate evidence based clinical outcomes.
Ensure navigation protocols that require collaboration with providers transition seamlessly across the continuum.
Ensure health navigators communicate and collaborate with providers to establish clinical programs improve the quality and efficiency of care while providing value to all stakeholders.
Providing technical and Operational support to all internal and external stakeholders i.e., Case Management, Provider Partnerships, Claims Department, Business Development, Clinical Operations, regional office, third party administrators, brokers on provider relation matters
Corporate Governance
Ensure compliance to any regulatory or health sector changes e.g., changes in billing/payments requirements, changes in the health legislation affecting the business.
Ensure compliance to any regulatory or health sector changes including data privacy and keep abreast of changes in the health legislation affecting the business.
Leadership & Culture
Provide coaching, guidance, and mentorship to staff, promoting professional development and knowledge sharing within the team.
Key Competencies
Manage an up-to-date comprehensive provider panel
Provider onboarding and contracting
Qualifications
Bachelor’s Science degree in Nursing/Clinical Medicine & Surgery
Basic understanding of the concepts of insurance
Proficient in the use of Microsoft office suite and packages.
Relevant Experience
Minimum of 5 years of relevant working experience in a similar or equivalent with at least two years in Clinical Practice. Experience in Claims Processing is an added advantage.
go to method of application »
If you are qualified and seeking an exciting new challenge, please apply via Recruitment@jubileekenya.com quoting the Job Reference Number and Position by 8th September 2023. Only shortlisted candidates will be contacted.
Apply via :
Recruitment@jubileekenya.com
