Job Purpose
To provide integrated hospital-based care management for corporate and insured patients by coordinating clinical care, client support, payer communication while serving as g as a liaison and coordinator to specific corporate payers And participating in formulating strategic plans for the future growth of AKUHN business.
Key responsibilities
Corporate Relationship and Business Support
- Maintain strong relationships with Corporate Care Managers & TPA’s.
- Conduct one-to-one engagement with the care managers.
- Identify gaps in service delivery and give feedback to management.
- Explore business development opportunities which the hospital can take advantage of.
- Monitor & evaluate referrals from these corporate.
Corporate Operational Guidelines
- Coordinate smooth execution of corporate operational guidelines.
- Clinical Care, Coordination and Facilitation
- Coordinate care for scheme beneficiaries across inpatient, outpatient and diagnostic s
- Identifying high-risk patients (high cost, prolonged length of stay and re-admissions)
- Liase with clinicians to ensure timely service delivery aligned to patient needs and cover limits.
- Monitor the inpatient progress in the hospital.
Utilization/Financial management.
- Conduct utilization review for high cost and prolonged admissions
- Verifying itemized bills on daily basis and coordinating the same with the corporate care managers.
- Confirm benefits, limits and authorization to ensure appropriately and verify coverage and benefit with health insurer to ensure that the patient is appropriately billed.
- Coordinating availability of required services.
Advocacy Education Communication
- Advocates for the patients under specific schemes for needed services and educate accordingly, based on their limited cover.
- Coordinate communication between patients, clinicians, insurers and corporate partners.
- Resolve issues arising from patients, families, clinicians and payers.
Digital Health, Data & Reporting
- Utilize hospital information systems to track admissions, LOS, Utilization and discharges.
- Prepare periodic care management and utilization reports for management
- Support data- driven decision making for service improvement
Qualifications, Experience and Skills required:
- Diploma/bachelor’s degree in nursing
- Minimum 3 years nursing experience, both in acute / or critical care settings
- Minimum 2 years Care Management within insurance or corporate healthcare
- Minimum 3 years’ Hospital Care Management experience
Technical & professional competencies
- Hospital care coordination and utilization management
- Knowledge of clinical pathways and insurance benefit structures
- Understanding case-based costing added advantage
- Proficiency in hospital EHR and digital health systems
Personal characteristics & behaviors
- Strong communication skills & interpersonal skills
- Analytical and problem-solving ability
- Team player with resilience and patience
- Ethical decision making with high integrity
Gmail
Yahoomail