Essential Knowledge/Skills and Experience Required:

• Diploma in Nursing or Clinical Medicine
  
• Minimum of 2 years of experience in care management, medical claims and Call Centre
  

• Issuance of approval to insured members seeking both inpatient and outpatient care as per policy guidelines.
  
• Monitor cost, average length of stay on inpatient cases.
  
• Issue guidance on Pre-authorized optical, dental and scheduled procedures
  
• Conduct Hospital visits whenever the insured members are hospitalized
  
• Respond to stakeholder inquiries on cases involving medical care management.
  
• Receive and respond to Medical emergency lines and ensure 24-hour coverage
  
• Negotiate for discounts from doctors and hospitals on specific cases and procedures from time to time
  
• Facilitate referrals and medical evacuations when need be.
  
• Monitor benefits utilization and share timely updates to the stakeholders.
  
• Prepare and share timely reports as may be guided.