Assistant Manager, Care Navigation at Jubilee Insurance

Job Ref. No: JHIL092

Role Purpose

As the Assistant Manager, Care Navigation, you would be responsible for handling all inpatient and specialized test preauthorization, and communicating with providers, clients, and brokers on a timely basis for any undertakings, rejections, or relevant concerns.

Main Responsibilities
Strategy

• Improve business retention by actively engaging the company’s clients in care navigation.
• Ensure full utilization of Jubilee Health Insurance’s navigation and wellness programs.

Operational

• Ensure navigation Programs using evidence-based guidelines add value, drive clinical performance, improve retention, and reduce disparity.
• Implement disease management programs and care coordination through the continuum of care.
• Ensure optimal update of case management concurrent review notes.
• Ensure implementation of population health strategies that address the utilization, quality, average cost of care, patient satisfaction, and overall marketplace competitiveness.
• Regularly develop a database of statistics and narratives for tracking progress and efficacy of treatments and activities for care navigation outcomes and incidence rates.
• Ensure high enrollment of members to the Jubilee Mum’s Wellness Club, Chronic disease management program and loyalty program.
• Designing and implementing navigation care plans and programs by offering support and tracking progress.
• Support call center staff by coordinating navigation, training, and escalation processes regarding the Company Navigation programs.
• Participate in member education and training to clients on the various navigation programs in the business.
• Ensure care navigation functions realize quality improvement in medical management, improve quality and access to care, reduce claims costs and demonstrate evidence based clinical outcomes.
• Ensure navigation protocols that require collaboration with providers transition seamlessly across the continuum.
• Ensure health navigators communicate and collaborate with providers to establish clinical programs improve the quality and efficiency of care while providing value to all stakeholders.
• Providing technical and Operational support to all internal and external stakeholders i.e., Case Management, Provider Partnerships, Claims Department, Business Development, Clinical Operations, regional office, third party administrators, brokers on provider relation matters

Corporate Governance

• Ensure compliance to any regulatory or health sector changes e.g., changes in billing/payments requirements, changes in the health legislation affecting the business.
• Ensure compliance to any regulatory or health sector changes including data privacy and keep abreast of changes in the health legislation affecting the business.

Leadership & Culture

• Provide coaching, guidance, and mentorship to staff, promoting professional development and knowledge sharing within the team.

Key Competencies

• Manage an up-to-date comprehensive provider panel
• Provider onboarding and contracting

Qualifications

• Bachelor’s Science degree in Nursing/Clinical Medicine & Surgery
• Basic understanding of the concepts of insurance
• Proficient in the use of Microsoft office suite and packages.

Relevant Experience

• Minimum of 5 years of relevant working experience in a similar or equivalent with at least two years in Clinical Practice. Experience in Claims Processing is an added advantage.