Case Manager

JOB OBJECTIVE

• Ensures enrollee’s are managed according to internationally acceptable clinical guidelines while also ensuring cost efficiency
• Responsible for the facilitation of effective coordination and continuity of care as enrollee transitions across providers and specialists.

KEY SKILLS & COMPETENCIES REQUIREMENTS

• Case Management (Admitted enrollees, usually when they are there or discharged recently. It is a care management and control process)
• Hospital Visitation when indicated
• Care follow up and counselling when indicated – virtual or physical visit
• Care approval and follow up for complex and intensive care cases
• Ensuring care is in line with applicable benefits and following up on approvals and patient care progress.
• Scheduling patients for major and highly specialized procedures
• Care review for admitted patients and complex cases requiring secondary and tertiary care
• Holding clinical meetings monthly to discuss cases and adjust protocols where necessary for better/improved outcomes when required
• Investigate the root cause of death of an enrollee at a partner hospital
• Identify quality gaps that may have occurred in the care of the enrollee and provide recommendations to the hospital to prevent a reoccurrence

EDUCATION/ PROFESSIONAL QUALIFICATION

• MBBS from a reputable tertiary institution.
• Possession of an MBA, MPH or other of similar equivalence will be an added advantage

EXPERIENCE: 3 – 5 years total work experience (Clinical experience)