Quality Assurance Nurse

Responsibilities

• Attend to and resolve all enrollees’ inquiries and ensure that all complaints are promptly resolved on first call resolution, or immediately escalated to the appropriate group or unit.
  
• Meticulously log all for management analysis and documentation for all relevant stakeholders.
  
• Follow-up on specific cases as assigned by the line manager for measurable outcomes and stakeholders’ satisfaction.
  
• Actively and proactively engage in the vetting of bills from the organization’s network of facilities providing secondary/tertiary healthcare services on the public sector social health insurance program
  
• Benchmark all received claims with the pre-authorized codes given by the call center as any service provided by any facility without a pre-authorized code is considered null and void.
  
• Review all the received bills and possibly contact the enrollees for authorization of services provided.
  
• Investigate and report any incident of abuse, neglect, or maltreatment of enrollees immediately to the Management for appropriate actions to be taken.
  
• Follow up on enrollees on admission to evaluate and document their progress and possibly assist the care team with developing and accessing health interventions.
  
• Participate in case management through scheduled and unscheduled visitation to enrollees on admission.
  

• Graduate Professional Nurse and First Degree from an accredited Baccalaureate Nursing Program (University)
  
• Must be a registered and licensed practitioner.
  
• Possession of recognized additional training in primary health care and midwifery is desirable
• Applicants must have at least 2 years experience as a Nurse and Midwifery Professional.
  
• Ability to work seamlessly with computers and other communication equipment and software.