CASE COORDINATOR, PROVIDER QUERIES OFFICER, HEALTH CARE COACH AND PROVIDER NETWORK OFFICER

 

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

Key Responsibilities

Case Coordinator

• Assists in the profiling of specialty institutions for prioritisation in management of members based on quality outcomes and afford ability;
• Establishes actual and potential health problems, goals for treatment and desired outcomes using the nursing process;
• Provides customer support through member education on hospital 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 reports on provider claims submitted, payments, and arrears;
• Applies information technology to improve service provider network coordination.

Healthcare Coach

• Provides effective solutions and suggestions on health and fitness issues;
• Suggests exercises, diet charts, meditation or mental stress reducing techniques to members;
• Promotes member self-management and empower members/families to achieve maximum levels of wellness and independence.

Provider Network Officer

• Participates in provider mapping in line with set guidelines to ensure adequate access to care for members;
• Participates 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.