Care Management Specialist

1 semana atrás

São Paulo, São Paulo, Brasil beBeeCare Tempo inteiro R$90.000 - R$110.000
Job Title: Medical Case Manager

Description:

We are seeking a highly skilled and experienced medical case manager to join our team. In this role, you will work closely with the senior manager of case management to provide ongoing support and expertise through comprehensive assessment, planning, implementation, and evaluation of cases.

The ideal candidate will have strong knowledge of medical conditions and correlations between medical conditions and potential medical expenditures. They will also have the ability to measure risk and potential impact of cases and claims for the business, as well as strong analytical abilities and attention to detail.

This is an exciting opportunity for a motivated and results-driven professional who is passionate about delivering high-quality patient care and services.


Responsibilities:
  • Review, monitor, and proactively assess all cases with a focus on those cases with a high-cost potential (daily and ongoing).
  • Assist and train medical coordinators to provide proper follow-up in high-cost cases.
  • Act as member advocate by investigating, documenting, reporting, and escalating adverse occurrences/situations to management.
  • Liaise and coordinate with medical professionals, administrators of healthcare providers, and members to ensure the cost-effectiveness and appropriateness of the treatment.
  • Maintain timely and thorough documentation of all interactions with healthcare professionals about member care to facilitate efficient claims processing.
  • Perform proper and detailed investigations of cases to ensure correct application of benefits.

Requirements:
  • A strong understanding of managed care policies and principles.
  • Ability to measure risk and potential impact of cases and claims for the business.
  • Strong analytical abilities and attention to detail.
  • Bilingual Portuguese – English (must be fluent in English) - speak, read and write.
  • Spanish fluency could be a plus.

Education and Experience:
  • A medical physician with a minimum of 5 years of related healthcare experience.
  • 3+ years of experience in healthcare working in medical coordination, case management and/or medical audit.

Necessary Knowledge:
  • Familiar with health insurance principles and guidelines.

Seniority Level: Associate
Employment Type: Contract
Job Function: Administrative and Customer Service
Industries: Insurance

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