Location: Kampala
Deadline: November 7, 2013 - 5pm
Resolution Health East Africa seeks to recruit a Care Manager & Provider Relations Administrator whose role purpose will be chiefly to interface with medical service providers and acquire the best service provision arrangements for our members. This position is only open to Ugandan citizens.
Key responsibility areas include:
Provider Relations
1. Undertake contracting of providers (hospitals and clinics)as per company protocols.
2. Administer the company’s accounts at providers.
3. Monitor and stock medical service providers with scheme documents and forms.
4. Manage processes to do with members’ direct access to specialists.
5. Conduct provider audits to ensure conformance with business requirements.
6. Undertake claims reconciliation with service providers and negotiate discounts.
7. Undertake provider training.
Provider Relations
1. Undertake contracting of providers (hospitals and clinics)as per company protocols.
2. Administer the company’s accounts at providers.
3. Monitor and stock medical service providers with scheme documents and forms.
4. Manage processes to do with members’ direct access to specialists.
5. Conduct provider audits to ensure conformance with business requirements.
6. Undertake claims reconciliation with service providers and negotiate discounts.
7. Undertake provider training.
Care Management
1. Coordinate the integration of care management functions into patient care
• Undertake pre-authorization and care management for scheme members for service access within and outside Uganda; Manage hospitalizations as per RIL care management protocol.
• In liaison with the physician maintain an appropriate cost, case and desired patient outcome
• Evaluate patient satisfaction and quality of care provided
2. Manage rescue and evacuations of members.
3. Assist members with chronic diseases on best practice disease management as per the RIL disease management protocol.
4. Maintain good relationships between providers and the company for the good of the scheme.
5. Coordinate International Emergency and Planned Admissions.
8. Undertake any third party recoveries as applicable.
9. Maintain all client pre-authorization records and hospitalization case notes records and provide weekly, quarterly & annual reports regarding care and provider operations as required.
1. Coordinate the integration of care management functions into patient care
• Undertake pre-authorization and care management for scheme members for service access within and outside Uganda; Manage hospitalizations as per RIL care management protocol.
• In liaison with the physician maintain an appropriate cost, case and desired patient outcome
• Evaluate patient satisfaction and quality of care provided
2. Manage rescue and evacuations of members.
3. Assist members with chronic diseases on best practice disease management as per the RIL disease management protocol.
4. Maintain good relationships between providers and the company for the good of the scheme.
5. Coordinate International Emergency and Planned Admissions.
8. Undertake any third party recoveries as applicable.
9. Maintain all client pre-authorization records and hospitalization case notes records and provide weekly, quarterly & annual reports regarding care and provider operations as required.
KEY COMPETENCIES:
• Good oral and written communication skills
• Exceptional commitment to customer service
• Good analytical and problem solving skills
• organized, able to prioritize work
• Good oral and written communication skills
• Exceptional commitment to customer service
• Good analytical and problem solving skills
• organized, able to prioritize work
SKILLS AND KNOWLEDGE:
• Diploma in Nursing or Clinical Medicine
• Diploma or degree in a business field
• In-depth knowledge of care and health management
• Diploma in Nursing or Clinical Medicine
• Diploma or degree in a business field
• In-depth knowledge of care and health management
EXPERIENCE:
• 3 years’ experience in care management in a large modern hospital
• Experience in a HMO/MIP an added advantage.
• Accounting knowledge an added advantage
• Knowledge of Microsoft Office with excellent skills in Excel
• Proficiency in driving with a valid driving License
• Outstanding communication skills - both verbal and written
• Exceptional commitment to customer service
• Good analytical and problem solving skills
• organized, able to prioritize work
• 3 years’ experience in care management in a large modern hospital
• Experience in a HMO/MIP an added advantage.
• Accounting knowledge an added advantage
• Knowledge of Microsoft Office with excellent skills in Excel
• Proficiency in driving with a valid driving License
• Outstanding communication skills - both verbal and written
• Exceptional commitment to customer service
• Good analytical and problem solving skills
• organized, able to prioritize work
How to apply:
If you believe you are a team player and would be a valuable resource to this ever growing brand, please:
1. Click or copy link below into the browser to register your application:
https://docs.google.com/forms/d/1vsxpuvdKwlmYxsyOvpxP_SShL8xSHdE8jsjftG4...
1. Click or copy link below into the browser to register your application:
https://docs.google.com/forms/d/1vsxpuvdKwlmYxsyOvpxP_SShL8xSHdE8jsjftG4...
2. Email your application to jobs@iaa-resolution.co.ug consisting of your application letter and updated CV listing three references, quoting the position in the email subject.
Only applications registered as per step 1 with a matching CV sent to us shall be considered.
Only shortlisted candidates will be contacted.
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