JOB DETAILS:

Job Scope:

The Care Manager will be part of the Health Insurance Business team and will report directly to the Head of Client Relations – Health.

This is a client facing and clinical role supporting the claim section within the health business. The incumbent will be responsible for treatment preauthorization, handling calls at the Call centre, and directly interacting with clinical personnel of accredited healthcare providers.

The successful applicant will have worked in a similar role within a busy serve organization and preferably the health insurance industry or a hospital setting in Uganda for at least three years.

Principal Accountabilities:

• Preauthorization of procedures and admissions.
• Handling customer queries and providing solutions through the call centre.
• Preparation of care management reports as required by management. Present monthly reports on overall inpatient and outpatient visits, customer satisfaction indices, including quarterly reports when required as per agreed outline to direct business services.
• Negotiating with specialists for more affordable but quality services to our clients.
• Vetting bills before discharge to minimize overutilization.
• Handling and coordinating patient emergencies.
• Assisting patients to access services in case of any challenges experienced during access of treatment. Respond to suggestions and compliments submitted by patients and provide positive reinforcements. Facilitate resolutions of compliments/grievances/requests for patients, visitors and assigned clinical service units.
• Compose letters or emails to patients, visitors, health system physicians, management ensuring content and grammatical accuracy.
• Carrying out scheme sensitisations where necessary and applicable.
• Carrying out day-to-day interactions with partner hospitals country wide to ensure good working relations.
• Participate on committees, work groups, and or process improvement teams that improve patient/customer satisfaction, e.g., wellness programmes.
• Detect, investigate, and manage fraud from both the clients and healthcare service providers.