UAP Old Mutual Group Case Management Nurse
UAP Old Mutual Group Case Management NurseIntroduction To control and manage benefits utilization through pre-authorization and case management, ensuring quality, appropriate and cost effective care for our members while safeguarding company interest .
Knowledge & Experience
Qualified practicing nurse-KRN or equivalent
2 Years in clinical setting
Skills & Competence
Excellent analytical skills
Good communication and negotiation skills
Excellent interpersonal relations skills
Good networking with Service providers and other medical insures
Pre-authorize scheduled and non-scheduled admissions within set guidelines and negotiate professional fees for each admission and on case by case for in-patient in consultation with Care Management Officer
Ensure that set parameters for admissions are adhered to
Implement a chronic condition management program for all our clients with chronic conditions
Visit all in-patients within Nairobi and its environs while liaising with the admitting doctors to ensure timely medical reports and smooth discharge and eventual preparation of case report of each admission on discharge and arranges post-hospitalization care.
Develop and maintain a database on admissions, clinical statistics/profiles
Liaise with other medical schemes for purposes of evaluating medical risk
Participate in product presentation and health talks activities on a need basis
Assist in management of the Preferred Service providers
Answer incoming telephone calls into the Call Center in a professional manner at all times with an efficiency of above 95%.
Managing requests for services from providers, intermediaries and clients, providing information on the UAP provider network, available benefits per scheme policy and services and other routine information. Provides health information to customers via UAP approved resources
Completes accurate and timely documentation on CRM of all services provided to callers and escalation of any issues which require further consultation.
In conjunction with Smart applications resolve card issues raised at the point of service.
Normal information center duties. E.g. carrying out customer surveys, social media and email management
Key Result Areas & Performance Indicators
Case Management of all admissions as per set guidelines
Cost reductions as per the set targets.
Pre-Authorization of all admissions within 6 hrs
All professional fees charges to be within pre-negotiated or set fess guidelines
Minimized identifiable cases of fraud
Processing of retail and cooperate outpatient claims
Provide monthly admission report for retail and weekly for Corporate clients
How to Apply
For more information and job application details, see; UAP Old Mutual Group Case Management Nurse
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