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Clinical Case Manager
2 weeks ago
To provide professional oversight of all medical escalation cases, to ensure medical appropriateness of treatments and that all associated charges are reasonable and customary.
**Key accountabilities**:
- a. Perform first line medical review for iXchange clients including pre-admission case review, determination of medical necessity, panel fee adherence, bill adjudication and case negotiation
b. Act as main liaison between Medical Director, Operations Manager and key external stakeholders (providers + payers) to provide key case details to facilitate timely approval and processing of claims
c. Communicate professionally and courteously with external clients and internal partners
d. Assist with case tracking, monitoring and reporting
e. Support learning and development program and participate in ongoing education, knowledge sharing and continuous improvement initiatives
f. Provide professional medical input to support iXchange operational efficiencies (may include development of digital platforms)
g. Support Marketing/Sales team in their business acquisition efforts from a medical case management perspective
h. Knowledge and adherence to company policies and procedures
i. Achieve relevant objectives /KPI’s as outlined by direct manager
**Qualifications & Experience**:
- Nursing degree, Medical degree (not necessarily registrable with SMC) or similar clinical qualification
At least 5 years of experience in healthcare industry, with at least 2 years working in a clinical setting
Experience with insurance claim processing would be an advantage
Understanding of Singapore healthcare system including Table of Surgical Procedures (TOSP) and MOH Fee Benchmarks
**Additional Information**:
- We are looking for someone with the drive to make a difference in the healthcare financing space.
This is not an easy task as it is a fine balance between achieving optimal patient outcomes in a landscape of rapidly improving technology and simultaneous sustainable medical cost containment.
If you are a quick learner and see the long-term benefits of conquering this challenge, we would love to hear from you
