Position: Care Manager -Medical Insurance (For a Private Medical Insurance Company)
Employer: A Leading Private Medical Insurance Company offering Local and International Healthcare Solutions)
Ref No: SGK-CM_MI-02-2020
Job Category: Supervisory
Diploma or Degree in Medical, Insurance, Business Management or other related fields.
At least 3 years hands-on working experience as a Care Manager managing the medical accounts of the registered members with the company
Care Manager -Medical Insurance will perform the following duties:-
- Full adherence to policy terms of all insurance products, compliance requirements and company policies.
- Pre-authorize scheduled admissions/day cases within the set guidelines/TATs in liaison with Aetna.
- Assist in evacuations for emergency treatments.
- Liaise with Doctors on the day to day management of patients and obtain medical reports/ expected length of stay where indicated as well as discharge planning.
- Respond to queries from clients, intermediaries and service providers on preauthorization procedure.
- Liaise with providers to obtain cost estimates for planned procedures as applicable.
- Timely GOP placement to ensure smooth discharge process and co-ordinate any necessary post-hospitalization care.
- Develop and maintain monthly database on all admissions.
- Participate in member education including but not limited to wellness, benefits etc
- Promote process improvement and automation activities to maximize efficiency and accuracy.
- Active client engagement including but not limited to hospital visits.
- Liaise with claims and network teams to flag and prevent fraud.
Expected Salary:- Kshs. 80,000 - 100,000 plus generous benefits