Case Manager at Total Health Trust Ltd

Job Describtion

• To ensure specific cases are managed in order to receive the best outcome
• To facilitate the process of pre-authorisations and authorisations between the provider and the scheme and to give feedback to the relevant party concerned
• To resolve all queries from providers and members on specific cases and within the agreed SLA
• To vet specific case requests from providers and members to ensure that the treatment is cost effective and in line with best practice
• To ensure ongoing case management (including hospital visits) of high risk members and specific hospital cases
• To advise members on individual benefits and how to best utilize these benefits
• To adhere to and live the organizational values.

Requirements

• Candidate must be a registered nurse, midwife or possess B.Sc. Nursing with valid license.
• Candidate must have a minimum of Credit or Second Class Upper Division and additional medical qualification will be an added advantage
• Candidate must have minimum of 2 years clinical experience and experience in similar role in a Health Maintenance Organization (HMO) will be an added advantage
• Candidate must have advanced knowledge of NHIS regulatory guidelines, Medical Global Best Practices, Health Insurance, Products and Processes, and Scheme Rules
• Excellent organizational, communication (verbal and written), listening skills and attention to detail.
• Candidate must be very proficient in Microsoft office packages

Other requirements:

• Good organizational and planning capabilities
• Presentation Skills
• Conflict Management
• Interpersonal Skills
• Innovative and quick thinking capabilities
• Innovativeness
• Adaptive
• Decision Making skills
• Integrity
• Ability to work under pressure
• Adaptive, expertise, Result-Oriented, Relationship Skill
• Working with people
• Must be a good collaborator/Team player