Job Description
The Group wishes to invite applications from suitably qualified & experienced individuals to fill the Case Coordinator role that has arisen in our organization.
Duties and Responsibilities
Preauthorizes Optical, Haemodialysis, Chemotherapy, Radiology, Pathology, Surgical and Hospitalization Cases as per the guidelines in the Standard Operation Procedures.
Analyses all requests submitted by service providers and members and ensures correct awards are given on quotations for procedures.
Checks on the correct use of tariffs on quotations and rejects where services are inappropriate.
Captures all the Cases on the system and issues Personal Identification Numbers to cases admitted into Private Hospitals.
Advises members and service providers on awards payable by the Health Group.
Receives and resolves pre-authorization queries from service providers and members.
Attends to walk in clients and manage the front office desks.
Receives and resolves preauthorization queries from service providers and members.
Escalates complicated queries and complaints to the Team Lead Case Coordination.
Refers chronic and high-cost cases to the Disease Management team for further follow up.
Prepares and submits monthly reports to the Team Lead Case Coordination on preauthorised cases.
Qualifications and Experience
Diploma in Nursing/Health Sciences or the equivalent.
Registered by the Nurses Council of Zimbabwe.
Case Management experience in a medical aid or hospital environment experience spanning 2-4 years.
Clinical Procedure knowledge.
Clear verbal and written communication and the ability to prepare accurate reports.
Ability to plan and organise in line with job requirements.
Ability to analyse and solve work related problems to achieve the correct outcomes.
