Care Manager
Description
Resolution Insurance Company Ltd is a general insurer offering innovative and responsive insurance solutions. We have learned to adapt in this constantly changing society, and develop comprehensive products that are relevant to our clients. We currently have over 70,000 members in our fold and have partnered with over 750 medical service providers across East Africa; a strong network of hospitals, clinics and doctors.
In pursuit of our ambitious growth plan, we are looking to fill the position below in our Medical Department
POSITION SUMMARY & PRIMARY OBJECTIVE
The Care Manager’s purpose is to monitor, evaluate and coordinate patient care within the medical benefit to ensure quality, appropriate and cost effective care, ensuring good business relationship with existing, new and potential Medical Service Providers.
The jobholder will be expected to demonstrate leadership and professionalism and perform all duties in accordance with the organization’s policies and procedures, keeping in mind the overall business objectives.
QUALIFICATIONS / EXPERIENCE / KNOWLEDGE
Essential
• Degree/Higher National Diploma in Nursing or Clinical Medicine.
• RCHN Registration
• At least 1-3 years relevant working experience.
• Good interpersonal, communication and negotiation skills.
• Basic knowledge of computers and office operating programmes.
Desirable
• Experience in an Insurance company.
• A valid driving license.
• A proven ability to build strong client relationships and maintain an excellent customer focus.
KEY RESPONSIBILITY AREAS
1. Pre-authorization of admissions both emergencies and scheduled to ensure validity, legitimacy of admission, and advice on cover scope.
2. Liaise with medical service providers to obtain Resolution Insurance client’s medical reports to ensure they are getting optimal, quality care as most appropriate.
3. Negotiate favorable cost on service provision and professional fees for each admission to ensure clients are receiving cost effective care within the scope of their cover and within Resolution Insurance tariffs.
4. Manage the 24-hour helpline and ensure client enquiries are sorted to satisfaction within the set timelines and assist with medical emergencies logistics
5. Visit all admitted clients to ensure they are getting appropriate satisfactory care and that necessary advice and assistance is given from admission to discharge.
6. Pre-authorization of outpatient, dental and optical services and ensure appropriate member benefit utilization
7. Maintain proper records and send accurate weekly, monthly and quartely reports or as may be requested.
8. Coach, train and supervise care coordinators to deliver services to expected level by the organization to ensure quality service and client satisfaction
9. Facilitate interdisciplinary patient care to review treatment goals and identify post-hospital needs
CORE COMPETENCIES
The following Core competencies are the skills, knowledge and behaviors expected of an employee at Resolution Insurance 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
• Undertaking inpatient and outpatient cases
• Decisions in emergency situations
• Diverting clients to more cost effective service providers to enable them stay within scope of cover
• Decision to advocate for home-care and rehabilitation where deemed necessary
Application Instructions
If you believe you are a team player and would be a valuable resource to this ever growing brand, kindly email your: 1. Application letter 2. Updated CV listing three references 3. Expected remuneration package 4. Availability should you be offered the position
Email: info@resolution.co.tz