CASE COORDINATOR, PROVIDER QUERIES OFFICER, HEALTH CARE COACH AND PROVIDER NETWORK : Local Company Local Company



Job Summary


A leading organisation in the Heathcare Service Industry is seeking to recruit highly qualified individuals to join our team .Applications are invited from suitably qualigied and experienced candidates for the above mentioned positions.Key

Duties and Responsibilities


Key Responsibilities

Case Coordinator

• Assists in the profiling of specialty institutions for prioritizing in management of members based on quality outcome and affordability
• Establish actual and potential health problems, goals for treatment and desired outcomes using the nursing process
• Provides customer support through member education on hospitals benefits, preauthorization processes and discharge planning
Provider Queries/Officer
• Communicates outcome of queries through email or telephone daily to members and service providers
• Ensures availability of up to date provider claims submitted, payments and arrears
• Applies information technology to improve service provider network coordination
Health care coach
• Provides effective solutions and suggestions on health and fitness issues
• Suggest exercises, diet chats, meditation or mental stress reducing techniques to members
• Promotes member self-management and empower members /families to achieve maximum levels of wellness and independent
Provider Network Officer
• Participation in provider mapping in line with set guidelines to ensure adequate access to care for members
• Participation in evaluation of provider performance in line with agreed utilization management metrics
• Attends to provider issues/queries including claims, utilization, member grievances and inquiries in a timely and professional manner

Qualifications and Experience


Persons Specification
• Diploma in General Nursing
• At least 3 years’ experience in nursing
• Hands on hospital experience

How to Apply


Email your application together with your detailed CV to healthinsurance21recruitmant@gmail.com

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