Care Coordinator/Provider Manager at International Health Management Services (IHMS)

RESPONSIBILITIES OF CARE COORDINATOR/PROVIDER MANAGER

• Inspection of healthcare facilities and accreditation of new facilities for onboarding and re-credentialing.
• Annual recertification/re-credentialing of all Providers.
• Annual collection of LONI certificates from all Providers.
• Provider relationship management and Provider Forums.
• Provider staff education – Provider induction at sign-on and ongoing education.
• Scheduling and carrying out quality assurance (QA) visits.
•  Assist with Pre-authorization of care based on the company’s pre-authorization guidelines and procedure.
• Investigating complaints from hospitals and responding to such correspondences.
• Investigating medical-related complaints from clients and responding to such correspondences.
• Health promotion (education, screening, etc.) and health benefit utilization education for clients.
• Concurrent and retrospective reviews of Enrollee feedback
• Providing approved billing guides and tariffs to hospitals
• Providing timely reports on Provider management
• Providing IHMS with feedback on Provider Relationship with IHMS
• Following up and getting feedback from Enrollees on admission Care
• Ensuring all correspondences with Providers are documented in email, reporting structure, survey or formal report as much as possible.

Note; HMO experience will be an added advantage

CARE COORDINATOR DUTIES

• Reach out to Patients on Admission
• Call or visit Patients during or at most one (1) week after admission
• Use the structured template to collect Patient reviews on Providers
• Provide feedback and utilization data
• Get feedback from Enrollees on treatment at various facilities
• Report on Enrollee utilization for each facility every year
• Reduce overbilling and over treatment
• Follow-up issues raised by the Claims Department to help Providers improve services