Care Management (Mombasa) Job Zamara
Medical Jobs, Zamara Jobs.
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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.
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
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How to Apply
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