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CARE MANAGER

AAR Insurance Nairobi

Summary

To ensure quality and efficiency in case management as well as provision of quality medical service delivery to all our clients.

Ability to provide stellar customer service to clients.
Accuracy in assessment, interpretation and intervention on the various cases. Maintain a Customer satisfaction index of over 90%
Effective management of hospitalization costs
Accuracy and timeliness in providing progress reports on new and old cases Documentation and storage of clinical data.

Description

To provide quality customer care to all members
To negotiate rates and treatment protocols with providers with a view to keeping claims below 60%
To implement all care management protocols and ensure that all procedures of the company are adhered to in adjudication resulting in accurate medical assessment, interpretation and intervention
To manage the workflow process from pre-authorization, case management and necessary system updates for claim processing
To implement, and oversee the pre-existing & chronic disease management program with a view to securing savings for the company
Daily visit of all hospitalized to provide advice on coverage and care, and to manage timely discharge of clients
To prepare daily case management reports for discussion and planning courses of action that favor the company as per the scheme rules and guidelines
To report all admissions and issue committals for approved cases
To prepare weekly reports on admissions with detailed analysis on reason for admissions and plans to ensure non- recurrence through disease management programs
To monitor cost of treatment at the various providers and advise underwriting department, and management on the most cost effective providers to use
To communicate in a timely manner all rejections, deductions or declines to service providers and members with documentary evidence of the same.

Education
Master Of Nursing

Graduate with a degree preferably in Nursing, at least 5 years relevant experience,

More Details on Experience

Good understanding of Case Management.
Mature, team player with supervisory skills.
Proficient in the use of Microsoft office suite and packages.

More Details on Skills

Customer focused and Strong problem solving skills.

Excellent communication and interpersonal skills.

Emotional Intelligence