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Case Management Clinical Executive Job Old Mutual
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Key Responsibilities
- Pre-authorize scheduled and non-scheduled admissions within the set guidelines
- Negotiate/discuss professional fees as appropriate for each admission
- Set the appropriate parameters for each admission (claim reserve, initial authorized cost and duration)
- Visit all admitted clients within Nairobi region and its environ
- Liaise with Doctors on the day-to-day management of patients and obtain medical reports/ expected length of stay where indicated
- Ensure smooth discharge process and co-ordinate any necessary post-hospitalization/ step down facility care
- Revise reserves after discharge of member
- Collect feedback from admitted clients on quality and scope of service by the service provider
- Assist in carrying out verification and medical audit of claims/invoices before settlement
- Develop and maintain monthly database on admissions, large claims and extended length of stay.
- Respond to queries from clients, intermediaries and service providers
- Liaise with other medical underwriter for purposes of market surveys and development of new controls, standards and products
- Any other duty assigned by management
Key Skills and Competencies
- Excellent communication and negotiation skills
- Excellent public relations and interpersonal relationship skills
- Extensive networking with SP and other medical insurers
- Excellent analytical and monitoring skills
- Good IT skills in database management and office systems
- Good decision making in benefit utilization management
- High levels of integrity and honesty
Qualifications & Experience
- Diploma or Degree in Nursing
- Diploma in Insurance/ COP
- Degree in Health systems Management/ Business management
- 3 years’ experience in clinical setting +2 years in insurance set up
How to Apply
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