Care Coordinator/Provider Manager – Rivers needed at International Health Management Services

4 weeks ago

Job title : Care Coordinator/Provider Manager – Rivers

Job Location : Rivers

Deadline : March 06, 2024

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MUST BE A MEDICAL DOCTOR/ NURSE

RESPONSIBILITIES OF CARE COORDINATOR/PROVIDER MANAGER

  • Inspection of healthcare facilities and accreditation of new facilities for onboarding and re-credentialing.
  • Annual recertification/re-credentialing of all Providers.
  • Annual collection of LONI certificates from all Providers.
  • Provider relationship management and Provider Forums.
  • Provider staff education Provider induction at sign-on and ongoing education.
  • Scheduling and carrying out quality assurance (QA) visits.
  • Assist with Pre-authorization of care based on the company’s pre-authorization guidelines and procedure.
  • Investigating complaints from hospitals and responding to such correspondences.
  • Investigating medical-related complaints from clients and responding to such correspondences.
  • Health promotion (education, screening, etc.) and health benefit utilization education for clients.
  • Concurrent and retrospective reviews of Enrollee feedback
  • Providing approved billing guides and tariffs to hospitals
  • Providing timely reports on Provider management
  • Providing IHMS with feedback on Provider Relationship with IHMS
  • Following up and getting feedback from Enrollees on admission Care
  • Ensuring all correspondences with Providers are documented in email, reporting structure, survey or formal report as much as possible.

CARE COORDINATOR DUTIES

  • Reach out to Patients on Admission
  • Call or visit Patients during or at most one (1) week after admission
  • Use the structured template to collect Patient reviews on Providers
  • Provide feedback and utilization data
  • Get feedback from Enrollees on treatment at various facilities
  • Report on Enrollee utilization for each facility every year
  • Reduce overbilling and over-treatment
  • Follow-up issues raised by the Claims Department to help Providers improve services.

How to Apply for this Offer

Interested and qualified candidates should apply using the Apply Now button below.
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  • Care Coordinator/Provider Manager – Rivers jobs