Care Manager at AAR Insurance

Overall Purpose of the Job

• Reporting to the Supervisor Case Management, the Care Manager will ensure quality and efficiency in case management as well provide quality medical service delivery to all our clients. 

Key Responsibilities

• Handling the emergency office lines and responding to clients queries as they arise on a 24/7 basis.
• Negotiate rates and treatment protocols with providers with a view to keeping claims below 60%.
• Implement all care management protocols and ensure that all procedures of the company are adhered to in adjudication resulting in accurate medical assessment, interpretation and intervention.
• Manage the workflow process from pre-authorization, case management and necessary system updates for claim processing.
• Implement and oversee the pre-existing & chronic disease management program, follow up of clients after discharge from hospital with a view to securing savings for the company.
• Daily follow-up (Calling/Visits) of all hospitalized clients, to provide advice on coverage and care, manage end to end admission and discharge process of all clients.
• Prepare daily case management reports on admissions with detailed analysis for discussion and planning with action that favor the company as per the scheme rules and guidelines.
• Report on all admissions and issue relevant communication/letters for approved cases to all parties involved.
• Monitor cost of treatment at the various providers and advise underwriting department, and management on the most cost effective providers to use. 
• Communicate in a timely manner all rejections, deductions or declines to service providers and members with documentary evidence of the same.

Education, Experience & Competencies

• Holder of a Bachelor’s degree preferably in Nursing, 
• Have at least 5years relevant experience.
• Demonstrate a good understanding of case management.
• Proficient in the use of Microsoft office suite and packages.
• High level of Emotional Intelligence.
• Excellent Communication and Interpersonal skills.
• Customer focused with strong problem solving skills.