Medical Case Manager

QA Employment Consultant

Medical Case Manager

Responsibilities

  • 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.

Requirements

  • 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 christine@qa.sg 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.

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