Care Manager

ABOUT THE COMPANY

M.P. Shah Hospital is a Social Service league Hospital which has been in existence for the last 83 years, as a ‘not for profit’ organization. The Hospital has one single social objective of providing quality, affordable health care services to the community at affordable costs. It is a multi-super-specialty, state-of-the art, tertiary care hospital with a current capacity of 210 fully operational beds, 30 dedicated critical care beds, 10 renal dialysis units and 12 chemotherapy units. It provides all the modern out-patient and in-patient facilities with dedicated pavilions/ wards, specialty clinics, advanced radiology, pathology and Cath lab operations. We are going through exciting times of development and redefining the way health care is delivered in East and Central Africa region.

JOB SUMMARY

Qualifications &Legal RequirementsDegree/ Diploma in Nursing or Clinical Medicine.Previous experience in an Insurance company / Extensive understanding of the concepts of health insurance.Good interpersonal, communication and negotiation skills.Knowledge of computers and MS office operating programs.Proven ability to build strong client relationships and maintain excellent customer focus.

RESPONSIBILITIES

Implement strategies in collaboration with the healthcare team to reduce length of stay (LOS) and resource utilization, never compromising quality or outcomes.Ensure patients are in the appropriate level of care according to evidenced based, physician approved criteria and standards and prescribed plan of care.Ensure pre-authorizations for services are obtained in a timely manner.Facilitate the discharge planning process to ensure patient throughput by collaborating with the healthcare team.Report to Care Management leadership, the identification avoidable days and other Care Management measures including, but not limited, readmissions, saved days, core measure monitoring, interventions, and delays, to ensure data is accurately collected.Prioritize patient’s need for Care Management services based on: target/high volume Diagnosis-RelatedGroup, high cost, outlier, LOS, frequent inpatient admissions, unplanned readmission or significant variance.Identify risk factors for potential crisis intervention needs related to clinical diagnosis, prognosis and/or patient/family dynamics.Identify and report ethical situations to manager/medical director for resolution.Ensure the multidisciplinary discharge plan is consistent with the patient’s clinical course, continuing care needs and covered services. Evaluate on an ongoing basis the patient’s status and progress toward reaching goals set forth in the plan of care.Collaborates with patients, families and other members of the healthcare team to facilitate care coordination.Handle all patient care concerns in a prompt and courteous manner; assess and direct to appropriate person to deal with concerns as needed.Act as the liaison for insurance companies and other corporate clients and performing care management functions to ensure accurate and timely dissemination of information to insurances companies

REQUIRED SKILLS

Patient care, Medicine, Reporting, Stakeholder communication

REQUIRED EDUCATION

Diploma, Associate's degree