Reporting to the Head of Provider Services, Case Managers will
- Use clinical experience and established administrative policies, review and evaluate medical services being delivered to enrollees by provider hospitals and clinics, ensure compliance with agreed protocols, drug formulary and issued pre-authorizations from Avon HMO to the providers.
- Analyze trends for internal monitoring purposes and external reporting
- Liaise with other departments in order to improve overall customer service
- Uses available resources to promote quality, cost effective outcomes
- Perform other tasks assigned by supervisor.
- Associate degree in Nursing Or a graduate of an accredited school of Nursing
Required Work Experience:
- Five years of recent clinical experience in a defined specialty area, such as oncology, cardiology, neonatology, maternity, rehabilitation services, mental health/chemical dependency, orthopedic or general medicine/surgery
- Or five years of utilization review, case management, clinical or a combination of experience; three of the five years must be clinical experience.
- Previous case management and case note auditing experience.
Required Skills and Abilities
- Knowledge of quality improvement processes and demonstrated ability with these activities.
- Knowledge of contract language and its application.
- Ability to work independently, prioritize effectively and make sound decisions.
- Good judgment
- Demonstrated customer service, organizational and presentation skills.
- Demonstrated oral and written communication skills.
- Ability to persuade, negotiate or influence others.
- Analytical or critical-thinking skills.
- Ability to handle confidential or sensitive information with discretion.
- Ability to operate standard office equipment.
- Working knowledge of Microsoft Word or other word processing software.
- Team player
- Ability to drive.
This position is also Abuja, Port Harcourt, Calabar, Warri, Makurdi, Kaduna, Abakaliki