Consultant Care Management

KEY ROLES AND RESPONSIBILITIES

Care Management

• Manning calls on the 24-hour medical emergencies help lines
• Facilitate approval and authorisation for Emergency Inpatient hospitalisation e.g. post road traffic accidents from the insurance companies/underwriters.
• Outpatient treatment authorisation (off smart/ no card)
• Facilitate evacuation processes to ensure favourable outcomes and reasonable charge to clients.
• Preauthorization request processing and hospital procedure booking including maternity and theatre procedure bookings.
• Liaising with the Insurance companies in the process of undertaking and pre-authorizations.
• Provider panel management – ensuring required facilities are onboarded and favourable relationship is always maintained.
• Advocating for clients
• Negotiation of borderline claims
• Support with overseas referral
• Offer dedicated services to clients at their premises.

Reporting

• Provide data reports collected from various monitoring tools assigned to the role e.g. weekly and/or monthly reports.
• Trend analysis – hospital charges, cost of various packages etc

Value Adds

• Facilitation of admission and discharge processes for patients by securing all necessary documents and ensuring minimal participation by the patient during the admission or discharge.
• Facilitation of special care for admitted patients e.g haircuts for executive clients at the bed side/ flowers.
• Issuing Zamara gift packs - pack of diapers, branded get well / birth congratulations to admitted patients.

SKILLS AND QUALIFICATIONS 

• A Diploma in Nursing Sciences/ Clinical medicine
• Minimum of one (1) year working in a hospital set up/ health facility/medical insurance care department
• General understanding of the insurance industry is an added advantage.
• Capacity to build relationships
• Business etiquette
• Excellent interpersonal and customer service skills
• Team player
• Problem Solving skills
• Self-Driven
• Flexible to train