Care Service Management Officer at CIC Group

PURPOSE:

Responsible for accurate capture of inpatient undertakings, authorization, cost control and hospital length of stay management.

PRIMARY RESPONSIBILITIES: 

• Review and provide clinical and financial guidance on Outpatient /Dental/Optical and inpatient approval request
• 24-hour Call Centre coverage as per allocated shifts.
• Give financial undertaking on eligible cases with reference to the policy guide lines and benefits limits.
• Ensure the hospitals /doctors adhere to CIC admission procedures/cost guidelines
• Identify cases for potential risks /long stay or complex and notify the relevant stake holders in good time.
• Customer engagement through hospital visits and calls for all admitted patients to monitor progress clinically/financially and prepare daily feedback reports.
• Evaluate and facilitate referral cases and scheduled surgeries promptly once pre-authorization request have been received.
• Assess all bills during admission and on discharge to ensure treatment is consistent with illness declared and cost for items are also in line with the market rate/CIC rates.
• Promptly request for medical/progress report where applicable, review and make clinical decisions in line with CIC policy.
• Monitor benefits utilization and where necessary communicate to the contact person of scheme.
• Daily follow up on the progress of all admitted patients with doctors to evaluate progress, promote continuity of care and ensure improved health outcomes.
• Daily updates on patient condition to the scheme contacts and intermediaries.
• Review and prudent decision making on all overseas referrals
• Claims analysis and clinical recommendations to address health seeking behaviors and ensure cost management while maintaining good outcomes.
• Coordinate medical care monthly Rota and duty allocation and ensure comprehensive coverage of all shifts
• Timely preparation and submission of Care Management reports

Other Duties

• Carry out performance appraisal, coaching and mentoring staff;
• Participate in planning and budgeting for the department.

PERSON SPECIFICATIONS

Academic Qualifications

• Minimum of a Bachelor’s degree in Nursing (KRCHN).
• Health System Management is an added advantage.

Experience

• Up to three (3) years’ relevant experience in care management role/call Centre Management.
• Supervisory experience will be an added advantage.

Professional Qualifications

Registration with the Nursing Council of Kenya

Skills and Attributes

• Problem solving skills;
• Good analytical skills;
• Computer literate in MS Office and other office applications;
• Understanding of the working environment /competitors;
• Technical competence in Health Care insurance;
• Basic knowledge of regulations by AKI and IRA;
• High emotional intelligence;

If you have the aforementioned professional and academic qualifications and you are ready to execute the above mandate.