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Jubilee Insurance KE   |   Nairobi, Kenya   |   Log in or register to see the closing date

Care Manager

  • Diploma, Associate's degree
  • Medical, health
  • Experienced (senior worker)
  • Full Time
  • Permanent

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Job Summary

The job holder will be accountable for care management, visiting patients at the various service providers, and providing professional guidance on policy matters where requested, ensuring comfort and assistance of patient by the service provider, and communicating with providers, clients and brokers on a timely basis for any rejections or relevant concerns. The post holder will report to the Senior Care Manager and will be based at Head Office.


1. Obtaining daily reports of admissions in the various service providers

2. Broker/customer communications by communicating as necessary admission decisions on a timely basis
3. Care Management - Through due diligence, ensuring undertakings are issued in line with the policy provisions. Likewise for declines, ensuring that the decisions are accurate
4. Visiting of patients at the various service providers, obtaining details of patients to confirm that admitted members are the eligible policy holders/ dependents
5. Confirming that the treatment the member is given is covered by the policy purchased
6. Ensuring that the medical reports in the hospital are accurate and reflective of what is provided to the insurer and also confirm what the member understands or communicates
7. Ensuring proper care and treatment of patient within acceptable protocols without wastage by member/ provider
8. Reviewing medical pre-authorizations for compliance with applicable policy guidelines and giving guidance to the other care management team on any information collected during the visits to the hospitals
9. Interacting with clients, brokers and clinicians as needed, to resolve problems in a manner that is legal, ethical and consistent with the principles of the policy
10. Obtaining medical information from providers with written correspondence if necessary
11. Participating in care management meetings
12. Checking and confirming membership validity and benefits (from the scheme benefits file)
13. Handling of coverage enquiries with brokers, providers, members etc.
14. Vetting and confirming validity of the service given by the service provider in relation to the benefits covered, treatment given, adherence to provider panel rules and cost of treatment
15. Obtaining additional required information on claims from providers, brokers or clients
16. Liaising with our underwriting section on scope of cover for various schemes
17. Assisting in conducting provider audits wherever necessary
18. Client presentations and member education on wise utilization & risk management
19. Managing the 24-hour emergency helpline

General Information

Salary rangeNot specified
Additional informationNot specified
Contract type: Permanent
Job type: Full Time
Location: Nairobi
Area of work: Medical, health
Seniority: Experienced (senior worker)

Job Requirements

Required education: Diploma, Associate's degree
Required relevant work experience: 3 years
Required skills: Following care plans; Customer service; Quality management; Patient care; Training program planning
Required languages: English (Spoken: fluent | Written: fluent)

Jubilee Insurance KE

Banking, microfinance, insuranceCompany size: 1000+ people

Jubilee Insurance was established in August 1937, as the first locally incorporated Insurance Company based in Mombasa in 1937. Jubilee Insurance has spread its sphere of influence throughout the region to become the largest Composite insurer in East Africa, handling Life, Pensions, general and Medical insurance. Today, Jubilee is the number one insurer in East Africa with over 450,000 clients. Jubilee Insurance has a network of offices in Kenya, Uganda, Tanzania, Burundi and Mauritius. It is the only ISO certified insurance group listed on the three East Africa stock exchanges – The Nairobi Securities Exchange (NSE), Dar es Salaam Stock Exchange and Uganda Securities Exchange. Its regional offices are highly rated on leadership, quality and risk management and have been awarded an AA- in Kenya and Uganda, and an A+ in Tanzania.

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