Care Manager

REF: TNH/HRD/CM/03/2023

Reporting to Director Strategy & Innovation, the successful applicant will be the liaison person for patients and the Hospital. The role will be key in ensuring the process of patient care is of high quality, efficient and cost effective resulting in positive health outcomes throughout the patients’ journey.

ROLES AND RESPONSIBILITIES

• Enhancing and maintaining good relationship with corporate clients to increase and sustain business.
• Identifying gaps in service delivery and give feedback to management towards effective & efficient service delivery.
• Monitoring, evaluating, and ensuring smooth referral handling from corporates and admitting doctors.
• Coordinate smooth execution of corporate operational guidelines to ensure effective service delivery and enhancing good corporate relationship.
• Minimizing bad debt by advising patients on alternate levels of care facilities and by ensuring proper bill allocation has been done.
• Verifying itemized bills – daily and assessing coverage with health insurers to ascertain that the patient is appropriately billed, resulting in satisfied corporates and facilitating the discharge process of patients.
• Coordinating with the corporate Patient Progression Managers and ensuring that they promptly respond to the hospital on all queries/requests/preauthorization, to eliminate financial declines/exhaustion of insurance cover.
• Working with the marketing team towards obtaining market intelligence and being abreast with the changes occurring in the environment affecting the Hospital’s competitive position.
• Managing the institution’s admission and discharge process and overall bed management.
• Monitor patients’ turnaround time and apply corrective measures.
• Any other responsibilities that may be assigned to the job holder by the supervisor from time to time.

EDUCATION SKILLS AND EXPERIENCE

• Bachelor of Science Degree in Nursing (B.Sc.) or related field.
• 5 years’ experience working in busy hospital or claims management.
• Minimum 2 years’ experience in care coordination.
• Knowledge of insurance regulatory requirements and concepts.
• Knowledge of case management process and procedures.
• Professional qualification ACII/COP is an added advantage.
• Excellent communication and interpersonal skills, with a strong leadership aptitude.
• Awareness and sensitivity to diversity of culture, with excellent critical thinking and analytical skills.

CORE COMPETENCIES

• Leadership skills
• Drive and openness to learning
• Time management skills
• Interpersonal skills
• Patient care skills
• Basic counselling skills
• Effective decision making and judgement skills
• Research skills
• Analytical skills
• Attention to detail
• Planning and organizing skills
• Communication skills including presentation and facilitation skills
• Team working skills
• Accountability
• Integrity
• Confidentiality