POSITION SUMMARY & PRIMARY OBJECTIVE The Care Coordinator s overall purpose is to be the liaison to ensure that all relevant communication and authorisations for medical services to clients under the disease management program are seamlessly executed to ensure member satisfaction and client retention. The jobholder will be expected to demonstrate commitment and loyalty and perform all duties in accordance with the organization s office routines and procedures, keeping in mind the overall business objectives. QUALIFICATIONS / EXPERIENCE / KNOWLEDGE Knowledge & Experience Required Essential A diploma/degree in customer/public relation and related field. At least 1 year - 2 year relevant work experience. Previous experience in health care and insurance an added advantage. Excellent customer service and PR skills Excellent communication and interpersonal skills Desirable Good organization and problem solving skills Ability to work responsibly with or without direct supervision. ROLES AND RESPONSIBILITIES 1. Handle clients (internal and external) and providers queries on policy benefits details including but not limited to providers they can access, disease management follow up details in a timely manner. 2. Oversee and work within the systems designed to ensure consultations are arranged for chronic disease clients as needed including the active follow-up of chronic disease clients who do not present at the clinic for care. 3. Management of the disease management helpdesk and management information system operations and implementations. 4. Dissemination of relevant management reports essential for program monitoring and evaluation. 5. Assemble and analyze data to prepare monthly and departmental reports and documents. 6. Manage and maintain schedules, appointments and travel arrangements. 7. Follow up on phone and in written form to confirm receipt of letters or necessary referral communication on comprehensive care. 9. Provide preauthorization of services for clients under the Chronic disease management program In liaison with dmp care manager. 10. Ensure all the clients under chronic disease management have a comprehensive management plan and care arrangement. 11. Coordinate and actively participate in health promotion,Education and preventive chronic disease activities. 12. Provide support in the Maintenance of the chronic disease management register and records. 13. Provide administrative support system to medical service provider to ensure all chronic disease checks are met. CORE COMPETENCIES The following Core competencies are the skills, knowledge and behaviors expected of an employee at Resolution Insurance Co. Limited. These competencies may need to be adjusted depending on the company s overall mission and values. Communication Skills Communicates clearly and professionally in written and oral forms to both internal and external clients. Initiative and Confidence Generates and acts on new ideas that add value to the business. Looks at different ways to solve problems and address difficulties. Achievement Drive Sets goals and strives to achieve them with enthusiasm and determination. Business Acumen Has a good understanding of the business environment and the impact their behavior has on the reputation of the company. Respect Treats colleagues and customers in a manner which demonstrates integrity, honesty and fairness. DECISION MAKING AUTHORITY Authorizations on access to services in liaison with care manager disease management. Client undertakings or decline of the same due to membership validity Advice clients on providers to visit in order to help manage their outpatient benefits WORKING RELATIONSHIPS Internal Purpose Membership Processing Clarification on client validity Medical Provider Supervisor Escalate complaints/issues raised by clients concerning providers. Account Executives Client renewals and benefits Underwriters Submissions of medical reports Claims Adjudicator Utilization reports and advice on balance/account statements. External Purpose Clients Authorization/advice on providers, data update Medical Providers Provide administrative support system to medical service provider and issue authorizations.
from Latest Jobs in Kenya | Capital FM Jobsfinder powered by Job Mail Kenya http://ift.tt/1HL2F5I
from Latest Jobs in Kenya | Capital FM Jobsfinder powered by Job Mail Kenya http://ift.tt/1HL2F5I
