Job Description

The position oversees care management and provider relations, including patient visits to offer policy guidance, ensuring patient comfort, coordinating pre-authorizations for admissions and medical cases, and addressing concerns with providers, clients, and brokers promptly.

Essential Functions:

• Recruit and accredit hospitals, clinics, pharmacies, and specialists.
• Train medical providers on products and claims processes.
• Maintain strong relationships with service providers.
• Resolve customer service issues related to medical services.
• Manage healthcare costs by ensuring care aligns with policy coverage.
• Ensure compliance with healthcare regulations and ethical standards.
• Develop care plans for chronic diseases, maternal care, and critical illnesses.
• Advocate for policyholders to access necessary healthcare services.

Competencies:

• Exceptional leadership and team management skills
• Strong analytical and critical thinking abilities
• Effective communication and interpersonal skills
• Strategic vision and decision making prowess
• Thorough understanding of healthcare regulations and insurance practices
• Clinical knowledge and experience

Qualifications and experience:

Degree/Diploma holders preferably in clinical medicine  

3+ year’s current care management experience