Purpose for the Job

To link Minet and all clients covered under Minet managed medical care schemes, ensuring that agreed care packages/residential/nursing placements are administered.

Duties and Responsiblities

Operational Roles and Responsibilities

• Case Management through daily hospital visits and patient reviews
• Costs negotiations with providers for hospitalized members
• Vetting of bills to ensure no double billing and proper application of agreed packages and price lists
• Seamless facilitation of evacuations by road or air
• Discount negotiations and step-down implementation
• Facilitation of all in-patient admissions and discharges by ensuring prompt preauthorization and preparation of bills
• Escalate well-certified cases in need of overseas evacuation to the preauthorization team
• Fraud detection and management
• Service provider relations and training
• Identification of medical service providers for accreditation and coordinating collection of all relevant accreditation documents as guided by the Service Provider team
• Member sensitization and wellness activities within the county
• Organize Stakeholder engagement programs such as courtesy visits, training, and County Governance forums
• Preparation of reports such as Case Management notes, member sensitization reports, and county incident reports as per agreed timelines

Any other duty as may be assigned by the supervisor

Key Result Areas

• Customer Service.
• Policy guidance.
• Care options information.
• Discount negotiations/Cost Control.
• Medical guideline orientation.

Key Competencies

• Case management.
• Benefit coordination.
• Stakeholder management.
• Conflict resolution.
• Public Speaking.

Knowledge And Skills Required

• At least 3 years’ experience in relevant field.
• Communication skills.
• Detail oriented.
• Interpersonal skills.
• Negotiations skills.

Professional and Academic Qualifications

• A minimum of a Diploma in Clinical Medicine.
• A degree in a related field such as Clinical Medicine or Health Systems Management will be an added advantage.