Healthcare and MedicalContractorMid-level(3-5 yrs)
Job Description
This role involves providing integrated hospital-based care management for corporate and insured patients. The Programmes Assistant coordinates clinical care, client support, and payer communication while serving as a liaison and coordinator to specific corporate payers, and participating in the formulation of strategic plans for the future growth of AKUHN business.
Key Responsibilities
Corporate Relationship and Business Support
Maintain strong relationships with Corporate Care Managers & TPAs.
Conduct one-to-one engagement with the care managers.
Identify gaps in service delivery and provide feedback to management.
Explore business development opportunities for the hospital.
Monitor and evaluate referrals from corporate partners.
Corporate Operational Guidelines
Coordinate the smooth execution of corporate operational guidelines.
Manage clinical care coordination and facilitation.
Coordinate care for scheme beneficiaries across inpatient, outpatient, and diagnostic services.
Identify high-risk patients (high cost, prolonged length of stay, and re-admissions).
Liaise with clinicians to ensure timely service delivery aligned to patient needs and cover limits.
Monitor inpatient progress within the hospital.
Utilization and Financial Management
Conduct utilization reviews for high-cost and prolonged admissions.
Verify itemized bills on a daily basis and coordinate with corporate care managers.
Confirm benefits, limits, and authorization to ensure appropriateness; verify coverage with health insurers to ensure the patient is appropriately billed.
Coordinate the availability of required services.
Advocacy, Education, and Communication
Advocate for patients under specific schemes for needed services and provide education based on their limited cover.
Coordinate communication between patients, clinicians, insurers, and corporate partners.
Resolve issues arising from patients, families, clinicians, and payers.
Digital Health, Data, and Reporting
Utilize hospital information systems to track admissions, Length of Stay (LOS), utilization, and discharges.
Prepare periodic care management and utilization reports for management.
Support data-driven decision-making for service improvement.
Requirements
Qualifications and Experience
Diploma or Bachelor’s degree in Nursing.
Minimum of 3 years of nursing experience in both acute and/or critical care settings.
Minimum of 2 years of Care Management experience within insurance or corporate healthcare.
Technical & Professional Competencies
Expertise in hospital care coordination and utilization management.
Knowledge of clinical pathways and insurance benefit structures.
Understanding of case-based costing is an added advantage.
Proficiency in hospital EHR and digital health systems.
Personal Characteristics
Strong communication and interpersonal skills.
Analytical and problem-solving ability.
Team player with resilience and patience.
Ethical decision-making with high integrity.
How to Apply
Interested and qualified candidates should apply online through the Aga Khan University career portal at aku.taleo.net.
How to Apply
Interested and qualified candidates should apply online through the Aga Khan University career portal at aku.taleo.net. Follow the instructions provided on the application page.
