Case Manager at Total Health Trust Ltd

Responsibilities

• To ensure specific cases are managed in order to receive the best outcome
• To facilitate the process of pre-authorizations and authorizations 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
• Track and manage staff performance and co-ordination within the Case Management team
• To advise members on individual benefits and how to best utilize these benefits
• To adhere to and live the organizational values.

Qualifications

• Medical Degree (Doctor)
• Masters in Medicine or Public Health - (Advantageous)
• 3-5 years Experience
• Experience in an HMO is an added advantage

Other requirements:

• Good communication 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
• Strategic