Care Manager

Qualifications & Experience

• Bachelor of Science Degree in Nursing (B.Sc.) or Diploma in Nursing.
  
• Valid Kenyan nursing practice license.
  
• Knowledge of insurance regulatory requirements and concepts.
  
• Extensive knowledge of insurance policies.
  
• Knowledge of case management process and procedures.
  
• Knowledge of legal regulations and best practices in healthcare.
  
• Professional qualification ACII/COP is an added advantage.
  
• At least 5 years’ experience working in busy hospital or claims management with at least 1 year in supervisory role.
  
• Minimum 2 years’ experience in care coordination.
  
• Key Competencies – Skills/ Knowledge/ Aptitude
  

1. Fostering the growth of patient volumes, in line with the annual budgets, through a focused delivery of high-quality care and patient-sensitive service that meets or exceeds the expectations of patients.
   
2. Care Management- Management of the quality of hospitalization by ensuring that all hospitalized members are visited and advised on whether their cases are payable or not by the providers with proper explanation. Ensuring that proper updates are given to management on a regular basis.
   
3. Patient Care- Become well acquainted with the wellness packages offered to provide accurate and prompt response to enquiries and advise patients on what packages to take. Handle complaints, provide appropriate solutions to patients and escalate the feedback as required.
   
4. Support the hospital’s medical tourism patient’s journey.
   
5. Ensure that 3rd party payers receive timely support, inclusive but not limited to medical reports, supporting cashiers with responses to invoice queries and bill estimates etc.
   
6. Data Analysis- Perform data analysis and prepare reports for service uptake. Continually review the wellness journey and feedback from patients, to offer suggestions to improve patient experience.
   
7. Customer Awareness-Coordinate wellness drives for corporate clients to ensure services are delivered as per agreed contracts.
   
8. Support the finance department with the clinical reconciliation process as well review of bills before dispatch to ensure closure of clinical gaps.
   
9. Business Development-Assist in activities to promote packages and following up on leads for potential clients.
   
10. Support patients through participation in hospital processes aim