Clinical Consultant job Vacancy In Uganda

Job Title: Clinical Consultant

Vacancy: Clinical Consultant- Case Manager
Location: Kampala
Country: Uganda
Job Description (Duties):

General description: The Clinical Consultant will work closely with the Clinical and Admin members of the Medical Insurance Division to ensure alignment of activities as well as the achievement of client Service level objectives. He/she is also responsible for the management of all pre-authorization and medical assistance requests for Medical Insurance members. He/she will liaise with the the client services contract center, service providers and other members of the multi-disciplinary team to ensure the best outcome for all members. An Integral component of the job is to follow-up all in-patient cases, telephonically, via e-mail or on-site visits and to review level of care , be involved in discharge planning and service provider negotiations on aspects such as level of care and downgrading of costs where appropriate, and monitoring of costs within service provider agreed tariffs.

Output/Core Tasks:

* Align activities to the Strategic objectives of the Business Unit.
* Work closely with other team members to ensure alignment of activities with client SLA objectives.
* Ability to work shifts and hours as specified by client requirements.
* Accept pre-authorization requested telephonically, email/fax;

1. Verify membership validity
2. Verify benefit available for treatment requested as per Insurer's benefit rules.
3. Assess medical necessity of treatment, appropriateness of facility, service provider and level of care - refer to medical protocols, consult with Clinical Manger/Medical Advisor as required or if uncertain.
4. Approve/decline request and communicate appropriately with member/service providers.

* Refer all requests for non-disclosure investigation where membership is less than 12 months, or elective surgery within 4months or where member has not been accepted on an underwriting free basis by the insurer.
* Attend to daily tasks as delegated , i.e mail-box, daily follow-up on pended requests.
* Follow-up and actively manage all in-patient cases and provide on-going feedback to update authorization information and benefits.
* Liaise with Hospitals, service provider contact persons, members and corporate clients on insurance decisions as required.
* Provide detailed feedback within the prescribed SLA time frame to clients.



Necessary Qualifications:

Qualifications and Knowledge;

* A degree or Diploma in Nursing.
* A post basic specialization in Critical care/Emergency Nursing is preferred.
* Registration with the National Authority/Registration board as a Professional Nurse.
* At least 3 years experience with the Managed Healthcare funding/Administration Industry.
* Knowledge of health insurance and healthcare risk management.
* Pre-Authorization Call Center experience preferred.
* Customer service experience.
* Knowledge of Industry legislation and medical insurance guidelines.
* Medical Insurance products and benefits knowledge.
* Clinical knowledge as it applies to the tariffs, diagnosis, treatment and medical care.

Competences;

* Good communication skills, verbal and written.
* Report writing skills.
* Driver's license.
* Ability to apply knowledge of legislation to day-to-day work.
* Initiate and implement process development.
* Computer literacy.
* Provide authorization within the policy guidelines and benefit rules.
* Critical evaluation of information.
* Ability to identify potential claims risk.
* Sound clinical decision making ability
* Liaison, coordination and consulting.
* Preparation of clinical status reports.
* Collation of medical reports for review by Medical advisor
* Helpful, friendly and accommodating.
* A customer focused attitude.
* Self-motivated, self-starter with a "go-getter" attitude.
* Critical, analytical.
* Assertiveness.
* Life long learner
* Coaching

How to Apply:

If interested, please submit in person a typed up-to-date CV and application letter with copies of your academic papers.

NFT Consult - Rwanda, Plot 8721, Golf Course Road, Nyarutarama, Kigali, Rwanda.
Tel: +250 252570099, +250 0755335419, +250 0785119453.

OR

NFT Consult – Uganda,Kisozi Complex, Plot 6/8 Kyaggwe Road, Nakasero
Tel: +256 0414237904 / 24, 0312266904

If applying online, please send an email to cejobs@nftconsult.com.

Attach your CV and application letter ONLY; please merge them into ONE file in MS word or PDF format.

DO NOT attach scanned academic papers or documents when applying online.