PURPOSE:

Responsible for care facilitation/cost containment and call centre reachability.

PRIMARY RESPONSIBILITIES:

Issuance of approval to insured members seeking both inpatient and outpatient care as per policy guidelines.

Monitor cost, average length of stay on inpatient cases.

Issue guidance on Pre-authorized optical, dental and scheduled procedures

Conduct Hospital visits whenever the insured members are hospitalized

Respond to stakeholder inquiries on cases involving medical care management.

Receive and respond to Medical emergency lines and ensure 24-hour coverage

Negotiate for discounts from doctors and hospitals on specific cases and procedures from time to time

Facilitate referrals and medical evacuations when need be.

Monitor benefits utilization and share timely updates to the stakeholders.

Prepare and share timely reports as may be guided.

Key Skills, Knowledge, Experience and Behavioural Competencies

Academic and Professional Requirements

Education    Minimum Qualification – Diploma in Nursing or Clinical Medicine

Experience Required:

 Description    Required years of experience

Relevant experience in Care Management, medical claims and call centre    2