Purpose:
Responsible
for care facilitation/cost containment and call centre reachability.
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.
Requirements:
Education
- Diploma in Nursing or Clinical Medicine
- Computer literate in MS Office and other
office applications
Experience Required:
- 2 years Relevant experience
in Care Management, medical claims and call centre
How To Apply
