Medical Case Manager
QA Employment Consultant
Medical Case Manager
- Take initial calls from policyholders in relation to medical claims or enquiries:
- Establish the purpose of the call and determine the salient points in a timely fashion without exploring unnecessary avenues
- Establish whether the caller has a valid policy in place using all available resources
- Document the facts of the case on the Case Management System (CMS)
- Provide advice on the documentation required to proceed with a claim
- Provide clinical leadership and guidance to the team to ensure members receive timely and accurate cover decisions, allowing them to progress with their treatment.
- Arrange care with an appropriate medical team/medical facility utilizing company network providers wherever possible
- Assess any proposed treatment plans for medical necessity and to ensure they fall within policy terms and conditions
- Ensure that treatment delivered is appropriate at all times by monitoring ongoing treatment plans and medical updates for individuals.
- Monitor patient progress and liaise with the provider to ensure the member is discharged to an appropriate environment.
- Liaising with treating medical staff, providers and with medical staff in order to manage cases efficiently and ensure the very best care plan is established for patients.
- Maintain accurate case records on the CMS system to include details of care delivered and all related communication.
- Make sure that treatment received and delivered meets policy requirements and standardization.
- Communicate effectively with all parties providing relevant information to:
- Clients and treating medical team
- Members of the team
- Patients and their families.
- Ensure that costs remain routine and customary for the care delivered.
- Medically audit provider invoices where necessary.
- Preferred to have at least 5 years of nursing experience, with at least 1 year in A&E Department
- Can do call centre duties
- Can access the patient’s condition on the first level
- Able to communicate fluently with Japanese callers
Interested applicants please send your resume to email@example.com or call 6337 7449 for more information
(Wong Yen Yong Christine, EA Registration No: R1101725)
To apply for this job please visit www.qa-employment.com.