PURPOSE:
Responsible for care facilitation/cost containment and call centre reachability.
PRIMARY RESPONSIBILITIES:
- Issuance of approval to insured members seeking both inpatient and outpatient care as per policy guidelines.
- Monitor cost, average length of stay on inpatient cases.
- Issue guidance on Pre-authorized optical, dental and scheduled procedures
- Conduct Hospital visits whenever the insured members are hospitalized
- Respond to stakeholder inquiries on cases involving medical care management.
- Receive and respond to Medical emergency lines and ensure 24-hour coverage
- Negotiate for discounts from doctors and hospitals on specific cases and procedures from time to time
- Facilitate referrals and medical evacuations when need be.
- Monitor benefits utilization and share timely updates to the stakeholders.
- Prepare and share timely reports as may be guided.
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