About this role
PURPOSE: Responsible for care facilitation/cost containment and call centre reachability.
PRIMARY RESPONSIBILITIES:
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Issuance of approval to insured members seeking both inpatient and outpatient care as per policy guidelines.
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Monitor cost, average length of stay on inpatient cases.
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Issue guidance on Pre-authorized optical, dental and scheduled procedures
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Conduct Hospital visits whenever the insured members are hospitalized
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Respond to stakeholder inquiries on cases involving medical care management.
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Receive and respond to Medical emergency lines and ensure 24-hour coverage
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Negotiate for discounts from doctors and hospitals on specific cases and procedures from time to time
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Facilitate referrals and medical evacuations when need be.
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Monitor benefits utilization and share timely updates to the stakeholders.
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Prepare and share timely reports as may be guided. Academic and Professional Requirements
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Minimum Qualification - Diploma in Nursing or Clinical Medicine Experience Required: Two years of relevant experience in Care Management, medical claims and call centre