Summary
Date Posted: Tuesday, March 16, 2021 , Base Salary: Not Disclosed

JOB DETAILS:
UAP GROUP
Old Mutual Limited (OML) is a premium African financial services group that offers a broad spectrum of financial solutions to retail and corporate customers across key markets in 17 countries. Our primary operations are in South Africa and the Rest of Africa, and we have niche businesses in Latin America and Asia. We have 12 million customers and 31,000 employees as at the end of 2017 and with over 170 years of heritage across sub-Saharan Africa, we are a crucial part of the communities we serve and broader society on the continent. The business is listed on the Johannesburg, London, Zimbabwean, Malawian, and Namibian stock exchanges. The UAP Old Mutual Group comprises of three key players as a result of the acquisition of a controlling stake in Faulu in 2014 and UAP in 2015 by Old Mutual. The acquisition resulted in Old Mutual Kenya and UAP Holdings (www.uapoldmutual.com) as well as Faulu Microfinance Bank (www.faulukenya.com) forming one of the largest financial services groups with a growing footprint in East and Central Africa. The Group currently has operations in Kenya, Uganda, Tanzania, South Sudan and Rwanda. The Group now offers customers a comprehensive and enhanced range of financial services which include Investment, Insurance, Banking, and Savings as well as a wider and more accessible distribution network..

JOB SUMMARY
Evaluates what services are considered medically necessary and work with different service providers to ensure that the required services are being given in the appropriate setting and attempt to control cost .

KEY TASKS AND RESPONSIBILITIES
• Supervise Pre-authorization of scheduled and non-scheduled admissions within the set guidelines and carry out verification and medical Audit of claims/invoices before settlement.
• Negotiate/discuss professional fees as appropriate for each admission.
• Set the appropriate parameters for each admission (claim reserve, initial authorized cost and duration).
• Prepare utilization reports of clients on a weekly, monthly, and quarterly basis.
• Develop and implement a chronic condition management program for all our clients with chronic conditions.
• Carry out monthly review of reserves.
• Provide monthly reports on admission cases.
• Liaise with other medical schemes for purposes of evaluating medical risk.
• Ensure that all amounts owed by third parties (e.g. contributing policies such as other medical policies, NHIF GPA, PA, travel, etc..) are fully recovered.
• Participate in product presentation and health talks activities on a need basis

SKILLS
• Good interpersonal skills
• Good verbal and written communication skills
• Thorough understanding of policy covers/wordings and their interpretation as pertaining to claims.

QUALIFICATIONS
• University degree in nursing
• 2 years’ experience in the same role

Work Hours: 8

Experience in Months: 24

Level of Education: Bachelor Degree

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Job application procedure

Method of Application
Submit your CV and Application on Company Website : Click Here https://oldmutual.wd3.myworkdayjobs.com/en-US/Old_Mutual_Careers/job/Kigali/Case-Management-Nurse_JR-8111 

Closing Date : 23rd March, 2021

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