Role of Purpose

To manage medical cases, both elective and emergencies, ensure quality care with special focus on exceptional customer service and balance financial saving in the Hospital.
Duties and Responsibilities

Check policy details and complete a preauthorization claims log.
Sending approval request to insurance companies after obtaining all necessary initial documents (completed... pre-authorization forms, medical reports, estimated length of stay and cost estimate) with coverage recommendations in timely fashion.
Plan and execute full range of case management actions for all complex, high cost and contested cases for end-to-end case and cost management in liaison with Insurance companies.
Check if coverage decision is appropriate as per the policy terms & conditions, particularly the full and partial denials.
Send coverage denials to doctors, members and Insurance companies once coverage decision is received, satisfactorily explaining the full or partial denials along with justifiable & timely answers to any additional queries.
Following up in a timely manner with doctors for additional medical and cost updates to justify further approval if a limited approval was given.
Review and coordinate with Insurance companies regarding any inaccurate full or partial denials, obtain and share additional medical information from the treating doctor where necessary and ensure that all cases are 100% accurate as per the policy terms.
Ensure full adherence to terms of all insurance products, compliance requirements and policies related to privacy of medical information.
Identify conflicts in patient care and make judgment calls as to the best path forward
Oversee the implementation of a patient’s medical plan
Deal with Insurance companies on matters concerning overdue debt follow ups, updated statements,

Qualifications

Bachelor Degree in nursing, clinical medicine, medical studies or other related medical field
Minimum three (3) years’ working experience in an insurance company or hospital facility as a care manager.
Complied with the requirements of Chapter Six (6) of the Constitution of Kenya.
Previous experience as a care manager is an added advantage more

Responsibilities
Reporting to the Pharmacy manager, the successful candidate will be responsible for the following amongst others:

Receive, verify prescriptions and dispense drugs within approved standards and procedures.
Contact physicians immediately for inaccuracy and illegibility in a prescription order, document errors and communicate them to the nursing and pharmacy staff
Verify expiry... dates of drugs prior to dispensing medication to patients.
Check labels placed on the medications contains the correct patient’s name, drug, quantity and directions.
Counsel patients on drug administration and use of devices for optimum wellness and recovery.
Prepare drug discharges to patients in the ward
Communicate out of stock and non-stock effectively and timely to doctors and nurses and provide alternative choice or make arrangements to order promptly.
Comply and observe the environmental health and safety measures and regulations by proper handling, storage and dispensation of medications
Conduct nursing floor inspections for all ward stock, solutions and patient medication left behind
Complete documentation of Interventions, Medication errors and Near Miss, Adverse events, Medication queries, Patient complaints or any other incidents and forward to relevant office
Maintain and update personal drug knowledge data base to ensure accurate provision of pharmaceutical care of general disease states as well as specialized knowledge in the assigned area of expertise
Prepare in-patient drugs according to their dosage and frequency orders for the patients
Ensure that all drugs dispensed to patients are quality drugs Receive, verify prescriptions and dispense drugs within approved standards and procedures.
Contact physicians immediately for inaccuracy and illegibility in a prescription order, document errors and communicate them to the nursing and pharmacy staff
Verify expiry dates of drugs prior to dispensing medication to patients.
Check labels placed on the medications contains the correct patient’s name, drug, quantity and directions.
Counsel patients on drug administration and use of devices for optimum wellness and recovery.
Prepare drug discharges to patients in the ward
Communicate out of stock and non-stock effectively and timely to doctors and nurses and provide alternative choice or make arrangements to order promptly.
Comply and observe the environmental health and safety measures and regulations by proper handling, storage and dispensation of medications
Conduct nursing floor inspections for all ward stock, solutions and patient medication left behind
Complete documentation of Interventions, Medication errors and Near Miss, Adverse events, Medication queries, Patient complaints or any other incidents and forward to relevant office
Maintain and update personal drug knowledge data base to ensure accurate provision of pharmaceutical care of general disease states as well as specialized knowledge in the assigned area of expertise
Prepare in-patient drugs according to their dosage and frequency orders for the patients
Ensure that all drugs dispensed to patients are quality drugs
Any other duties as may be assigned from time to time.

Qualifications

Diploma in Pharmaceutical Technology.
Enrolled with the Pharmacy and Poisons Board.
Possession of valid annual practicing license.
Two (2) years working experience.
Good communication skills, honest and good interpersonal skills. more

Duties and Responsibilities

Provide outstanding customer services to patients, public and Plainsview Hospital staff and ensure inquiries and complaints to the department are addressed expeditiously
Consistently provide full coverage at all times at the front desk
Apply all functional computer applications to process daily front office transactions at compliance level standards
Register all... patient’s bio-data accurately
Beware of the down time and data protection procedure in the event of a system failure
Verify and confirm credit services that are applicable to corporate employees as per the account entitlement details
In liaison with the relevant stakeholders, ensure that pre-authorizations are duly completed by the physician and sent to corporations for approval within 24hours
Ensure accurate billing and data entry of patients
Ensure patient biometric registration is done
Assist other patient services staff when the need arises in order to foster overall efficiency of the department and deliver timely patient care
Answer both internal and external phone inquiries and respond appropriately. Communicate messages promptly and accurately to concerned persons in order to help in the maintenance of smooth organization of patient care
Re-confirm and update the contact details of patients.

Qualifications

Diploma in Front Office Administration, Business Administration or an equivalent qualification
1 years working in a busy front office preferably in a hospital set-up
Excellent interpersonal, communication & customer care skills.
Computer literate
Dedication and strong willingness to affect change with an understanding of challenges often encountered
Ability to manage multiple tasks effectively with frequent interruptions, and to work productively in a fast paced, rapidly growing organization
Must be flexible with changing job requirements as the team grows
Proven mastery of Office applications including Outlook, Word, Excel and PowerPoint
Complied with the requirements of Chapter Six (6) of the Constitution of Kenya, more

Duties and Responsibilities

Clean and supply designated facility areas (dusting, sweeping, vacuuming, mopping,
cleaning ceiling vents, restroom cleaning etc.)
Perform and document routine inspection and maintenance activities
Carry out heavy cleansing tasks and special projects
Notify management of occurring deficiencies or needs for repairs
Make adjustments and minor repairs
Stock and... maintain supply rooms
The immediate supervisor may assign performing other duties as from time to time

Minimum requirements

Certificate in Housekeeping & Laundry
Minimum two years working experience.
Excellent Public Relations

Other Competencies

A team player
Possess good oral and writing skills in English
Ability to handle heavy equipment and machinery
Knowledge of cleaning chemicals and supplies

Integrity

Must have worked in a similar position in a similar position.
Experience in a hospital will be an added advantage. more