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Case Manager & Care Coordinator Uyo(Contract)
Reliance Health
This job is no longer accepting applications
See open jobs at Reliance Health.See open jobs similar to "Case Manager & Care Coordinator Uyo(Contract)" Ventures Platform.Lagos, Nigeria
Posted on Jul 20, 2024
The Case Management & Care Coordination Associate is responsible for analyzing and reporting fraud, waste, and abuse data, managing the escalation of emergency cases, conducting mortality investigations, overseeing general case management and care coordination activities, managing at-risk cases, and monitoring ICU admissions of enrollees receiving healthcare services from providers within the Reliance HMO Providers network.
Responsibilities
- Analyze claims data, billing records, and other relevant information to identify patterns, anomalies, and potential cases of fraud, waste, and abuse
- Utilize data analytics tools and techniques to identify trends, outliers, and potentially fraudulent activities
- Manage the escalation of emergency cases, ensuring timely and appropriate interventions for enrollees in critical or life-threatening situations
- Collaborate with healthcare providers, emergency services, and internal teams to coordinate and facilitate emergency care and support
- Conduct investigations into cases involving the mortality of enrollees to determine the cause, identify potential gaps in care, and assess the quality of care provided
- Collaborate with medical professionals, forensic experts, and internal teams to gather relevant information and conduct thorough investigations
- Monitor ICU admissions of enrollees, ensuring appropriate utilization and timely interventions, assessing the necessity and appropriateness of continued stay in the ICU
- Maintain accurate documentation of emergency cases, including communication, actions taken, and outcome
- Ensure compliance with applicable laws, regulations, and company policies related to fraud, waste, and abuse investigations, emergency case management, mortality investigations, general case management, managing at-risk cases, and ICU admissions
This job is no longer accepting applications
See open jobs at Reliance Health.See open jobs similar to "Case Manager & Care Coordinator Uyo(Contract)" Ventures Platform.