Umwanya w`akazi (Case Management Nurse) muri UAP Group: Deadline: 23-03-2021

Role Title:

Case Management Nurse-1 Post

Business Unit(s):

Rwanda

Business /Function:

Case Management Nurse

Location:

Rwanda

Reports To:

Health Manager

MDP Level:

Manager of self

Role Size

L

• Supervise Pre-authorization of scheduled and non-scheduled admissions within the set guidelines and carry out verification and medical Audit of claims/invoices before settlement.
• Negotiate/discuss professional fees as appropriate for each admission.
• Set the appropriate parameters for each admission (claim reserve, initial authorized cost and duration).
• Prepare utilization reports of clients on a weekly, monthly, and quarterly basis.
• Develop and implement a chronic condition management program for all our clients with chronic conditions.
• Carry out monthly review of reserves.
• Provide monthly reports on admission cases.
• Liaise with other medical schemes for purposes of evaluating medical risk.
• Ensure that all amounts owed by third parties (e.g. contributing policies such as other medical policies, NHIF GPA, PA, travel, etc..) are fully recovered.
• Participate in product presentation and health talks activities on a need basis