• Monitor daily hospital admissions, including weekends and overnight cases, by liaising with partner hospitals to obtain complete pre authorization documentation (forms, medical reports, cost estimates, and proposed length of stay).
  

• Assess and prioritize incoming cases by urgency, acknowledge receipts accordingly, and ensure emergency admissions are addressed immediately, and elective cases within 24 hours.
  

• Access member policy details using Navision, log all cases accurately, and ensure records are updated in real-time.
  

• Submit complete approval requests to international insurance partners, including recommended coverage decisions based on policy terms and medical necessity.
  

• Track and follow up on coverage decisions (full, partial, or denied), confirm alignment with policy terms, and issue Guarantee of Payment (GOP) or denial notices to providers, brokers, and members with clear, timely explanations.
  

• Engage with providers and treating physicians to obtain further clinical information or cost updates in cases of limited approvals, and advocate for appropriate extended coverage.
  

• Coordinate with insurance partners on contested decisions, provide additional supporting documentation where necessary, and ensure cases are resolved accurately and fairly.
  

• Escalate complex cases to senior management for final approval and communicate outcomes professionally to all relevant parties.
  

• Ensure full adherence to data privacy policies and the confidentiality of members' medical information.
  

• Utilize Navision for all pre authorization processing, minimizing manual handling unless approved for process improvement purposes.
  

• Handle internal claims department requests for GOPs or reports and ensure prompt resolution of inquiries.
  

• Visit hospitalized members regularly, conduct in-person reviews with doctors when needed, and maintain detailed hospital visit reports.
  

• Lead and contribute to continuous process improvement initiatives to enhance the efficiency and reliability of pre authorization operations.
  

As the weekly on-call supervisor, the Care Manager will also:

• Oversee the pre authorization function for the week, managing the emergency line and ensuring service continuity.
  

• Allocate new cases to team members and supervise progress to prevent omissions.
  

• Maintain the daily hospitalization tracker and ensure data accuracy.
  

• Monitor and respond to all departmental email queries in a timely and professional manner.
  

• Provide direct support to walk-in clients, including members, brokers, and healthcare providers.
  

• Support underwriting decisions as needed.
  

• Ensure the entire department operates smoothly and consistently meets service and compliance expectations during the assigned on-call week.
  

Requirements

• Diploma in Nursing or Clinical Medicine.
  

• Minimum of 2 years’ experience in healthcare or health insurance, preferably in case management or utilization review.
  

• Proficient in Microsoft Word, Excel, and Outlook.
  

• Familiarity with Navision or similar health insurance management systems is an added advantage.
  

• In-depth understanding of clinical processes, medical terminology, and insurance coverage guidelines.
  

• Exceptional organizational skills, attention to detail, and analytical thinking.
  

• Strong interpersonal and communication skills, with a customer-focused mindset.
  

• Commitment to ethical conduct and medical data confidentiality.