Medical Insurance Doctor – case manager

For over 30 years, APRIL International Care has been specializing in international health insurance solutions. We design, distribute, and manage insurance plans and assistance services for individuals and businesses. With teams across Asia, Europe, and the Americas, we look after our members wherever they are to ensure they have access to the best care. 

We are part of the APRIL Group, an insurance specialist with 3,000 staff in 20 countries. 

Are you passionate about improving member healthcare journeys and optimizing the costs? We are seeking a skilled and dedicated Medical Insurance Doctor - Case Manager to join our team in the APAC region. Step up the challenge and make a difference in member healthcare. 

As a Case Manager, you will play a vital role in managing complex clinical cases, with the dual objective of enhancing patient outcomes and optimizing treatment costs. Your strategic approach will be crucial in achieving these objectives while ensuring effective coordination across multiple teams. 

Responsibilities:

Ensure the medical appropriateness of treatment plans through adherence to evidence based- medicine for IPMI and assistance business.

Recognize situations where this is necessary to collaboratively challenge a provider and articulate effective communication strategies.

Challenge Doctor or medical provider (by email or call) when necessary to ensure the treatment plan is the best to treat the condition.

Communicate with the member or broker (by email or call) to explain the coverage decision on specific cases.

Engage members in their care journey by providing expert guidance, discussing alternative treatment options and facilitating access to second medical opinions when necessary.

Execute case management tasks to ensure timely progress and resolution of cases.

Actively participate in innovative cost containment initiatives by identifying and addressing instances of overutilization, over prescription and potential fraud, waste or abuse.

Anticipate future costs and take actions to prevent recurrence or complication of chronic diseases. Apply strategic thinking to optimize treatment plans and patient outcomes.

Prepare well-structured and concise case summaries as part of the escalation process, ensuring all relevant information is included.

Recommend high-quality medical providers and specialists when there is a specific request from a client or team or for steerage cases.

Contribute to the medical audit and quality assessment of existing and prospective healthcare providers within the APRIL network, ensuring a standard of excellence in care delivery.

Assist any other team who need medical expertise.

Ensure the continuity of the business by joining the roster Doctor and handover cases to the medical weekend team.

Requirements:

Candidates with medical background is a plus

Strong analytical and problem-solving skills, with the ability to develop innovative action plans

Extremely adept in negotiating 

Excellent communication skills, able to engage effectively with different stakeholders 

Knowledge of healthcare systems and clinical procedures is a plus  

Ability to work independently, prioritize tasks, pro-activity and meet deadlines in a fast-paced environment. 

Benefits:

Opportunities for professional development and continuous learning

Collaborative and inclusive work environment

Work-life balance and flexible working arrangements

Engaging and challenging work with a meaningful impact on patient care

Cutting-edge technology and resources to support your work

Supportive leadership and opportunities for career growth within the organization

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