Care Manager
2025-06-24T20:31:04+00:00
Priority Activator Consulting
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https://www.greatkenyanjobs.com/jobs
FULL_TIME
Nairobi
Nairobi
00100
Kenya
Consulting
Healthcare
2025-07-23T17:00:00+00:00
Kenya
8
Job Purpose:
Lead care management and utilization review functions, aligning medical decisions with underwriting principles, supporting pre-authorizations, ensuring quality outcomes, cost efficiency, and client satisfaction.
Key Responsibilities:
- Ensure smooth patient journey in accessing care. Outpatient – quick turnaround on pre-authorizations and Inpatient smooth admission and discharge process
- Manage pre-authorization, discharge, case review, and claims adjudication
- Monitor healthcare provider performance; recommend panel adjustments
- Oversee call centre operations; ensure resolution and protocol compliance
- Maintain accurate patient records for traceability and audits
- Liaise with providers, insurers, clients, and internal teams for service coordination
- Train internal staff on claims, clinical data interpretation, and care protocols
- Implement cost management strategies including negotiations with insurers, hospitals, doctors and other stakeholders.
- Develop and update case management protocols; ensure industry compliance
- Evaluate and manage provider panel; negotiate terms and contracts
- Support underwriting with expert medical opinions on complex cases
- Audit high-cost/long-term cases; recommend treatment alternatives
- Contribute to client education with wellness guidelines and utilization reports
Qualifications:
- Degree in Nursing, Clinical Medicine, or related field
- Certification in Health Insurance or Case Management (preferred)
- Advanced training in Utilization Review or Managed Care
Experience:
- Minimum 5 years in care management or medical underwriting
Skills & Competencies:
- Clinical proficiency; diagnostic and treatment standards
- Analytical acumen; medical records and coverage impact analysis
- Insurance literacy; policy and medical coding knowledge
- Communication and collaboration with stakeholders
- Detail-oriented; document accuracy and compliance
- Team leadership and capacity-building
- Problem-solving mindset; service and claims resolution
Ensure smooth patient journey in accessing care. Outpatient – quick turnaround on pre-authorizations and Inpatient smooth admission and discharge process Manage pre-authorization, discharge, case review, and claims adjudication Monitor healthcare provider performance; recommend panel adjustments Oversee call centre operations; ensure resolution and protocol compliance Maintain accurate patient records for traceability and audits Liaise with providers, insurers, clients, and internal teams for service coordination Train internal staff on claims, clinical data interpretation, and care protocols Implement cost management strategies including negotiations with insurers, hospitals, doctors and other stakeholders. Develop and update case management protocols; ensure industry compliance Evaluate and manage provider panel; negotiate terms and contracts Support underwriting with expert medical opinions on complex cases Audit high-cost/long-term cases; recommend treatment alternatives Contribute to client education with wellness guidelines and utilization reports
Clinical proficiency; diagnostic and treatment standards Analytical acumen; medical records and coverage impact analysis Insurance literacy; policy and medical coding knowledge Communication and collaboration with stakeholders Detail-oriented; document accuracy and compliance Team leadership and capacity-building Problem-solving mindset; service and claims resolution
Degree in Nursing, Clinical Medicine, or related field Certification in Health Insurance or Case Management (preferred) Advanced training in Utilization Review or Managed Care Experience: Minimum 5 years in care management or medical underwriting
JOB-685b0b0803d2b
Vacancy title:
Care Manager
[Type: FULL_TIME, Industry: Consulting, Category: Healthcare]
Jobs at:
Priority Activator Consulting
Deadline of this Job:
Wednesday, July 23 2025
Duty Station:
Nairobi | Nairobi | Kenya
Summary
Date Posted: Tuesday, June 24 2025, Base Salary: Not Disclosed
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JOB DETAILS:
Job Purpose:
Lead care management and utilization review functions, aligning medical decisions with underwriting principles, supporting pre-authorizations, ensuring quality outcomes, cost efficiency, and client satisfaction.
Key Responsibilities:
- Ensure smooth patient journey in accessing care. Outpatient – quick turnaround on pre-authorizations and Inpatient smooth admission and discharge process
- Manage pre-authorization, discharge, case review, and claims adjudication
- Monitor healthcare provider performance; recommend panel adjustments
- Oversee call centre operations; ensure resolution and protocol compliance
- Maintain accurate patient records for traceability and audits
- Liaise with providers, insurers, clients, and internal teams for service coordination
- Train internal staff on claims, clinical data interpretation, and care protocols
- Implement cost management strategies including negotiations with insurers, hospitals, doctors and other stakeholders.
- Develop and update case management protocols; ensure industry compliance
- Evaluate and manage provider panel; negotiate terms and contracts
- Support underwriting with expert medical opinions on complex cases
- Audit high-cost/long-term cases; recommend treatment alternatives
- Contribute to client education with wellness guidelines and utilization reports
Qualifications:
- Degree in Nursing, Clinical Medicine, or related field
- Certification in Health Insurance or Case Management (preferred)
- Advanced training in Utilization Review or Managed Care
Experience:
- Minimum 5 years in care management or medical underwriting
Skills & Competencies:
- Clinical proficiency; diagnostic and treatment standards
- Analytical acumen; medical records and coverage impact analysis
- Insurance literacy; policy and medical coding knowledge
- Communication and collaboration with stakeholders
- Detail-oriented; document accuracy and compliance
- Team leadership and capacity-building
- Problem-solving mindset; service and claims resolution
Work Hours: 8
Experience in Months: 60
Level of Education: bachelor degree
Job application procedure
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