Openings 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.

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Job Ref. No: JHIL091

Role Purpose

As the Strategic Purchasing Executive, you would be responsible for establishing and maintaining relationships with healthcare providers to ensure a robust and high-quality network of medical services for policyholders. This role involves collaboration with internal and external stakeholders to optimize provider partnerships.

Main Responsibilities
Strategy

• Maintain relationships with Specialists, administrative staff for specialists and other key Specialists’ influencers and provide a clear link between these and Jubilee Health Insurance.
• Act as a liaison between Specialists and Jubilee Health Insurance limited to resolve problems, provide, and obtain information, and maintain positive working relationships with Specialists.

Operational

• Negotiation of cost of services rendered by medical providers.
• Monitoring Average Costs of providers and engaging high-cost providers for cost reduction.
• Implement initiatives that help reduce the cost of drugs such as drug delivery, generic drugs utilization among others.
• Develop a tracking system for and ensure timely follow-up of doctors’ payments is done.
• Ensuring all cost Agreements have been Setup in the System, i.e., Co-pays, Discounts, Micro Schemes and Restricted Categories/Providers.
• Provide guidance to the care management team, claims team, and contact center agents on provider cost issues.
• Support the business development and underwriting team in client servicing.
• Monthly reports on effectiveness of systemized cost control and saving achieved.
• Pre-authorisations monitoring to determine IBNR.
• Providing a report on claims status. Indicating outstanding claims, assessed and registered claims.
• Link, guide and communicate with prospective specialists through the credentialing process.
• Document all Specialists office interactions and other pertinent information in applicable databases to provide an accurate record of Specialist encounter history.

Corporate Governance

• Assist in carrying out country-wide provider audits to ensure that quality, cost effective medical services can be guaranteed for clients.

Leadership & Culture

• Promote a customer-centric approach to provider partnerships, prioritizing policyholder satisfaction and positive health outcomes.
• Collaborate with internal stakeholders to drive cultural transformation and organizational alignment around provider partnership goals and strategies.

Key Competencies

• Negotiation
• Performance reporting and management.
• Relationship Building skills
• Health Benefit Plan Management.

Qualifications

• Diploma in Nursing/Diploma in Clinical Medicine & Surgery
• Basic understanding of the concepts of insurance
• Proficient in the use of Microsoft office suite and packages

Relevant Experience

• Minimum of 2 years of relevant working experience in Case Management