Case Management Nurse at Old Mutual Kenya

Old Mutual Kenya is based in Nairobi and is part of a larger group that offers solutions in long-term savings, asset management and investment. We offer solutions to individuals and corporates underpinned by our core values which are: Respect, Integrity, Accountability and Pushing beyond boundaries.
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Case Management Nurse

  • Job TypeFull Time
  • QualificationBA/BSc/HND , Diploma
  • Experience1 year
  • LocationNairobi
  • Job FieldMedical / Healthcare 

Job Description

  • To control and manage medical benefit utilization through preauthorization and case management activities and ensure quality, appropriate cost effective care and good customer service

KEY TASKS AND RESPONSIBILITIES

  • Pre-authorize scheduled and nonscheduled admissions within the set guidelines.
  • Negotiate/discuss professional fees as appropriate for each admission.
  • Set the appropriate parameters for each admission (claim reserve, initial authorized cost and duration).
  • Visit all admitted clients within Nairobi region and its environs
  • Liaise with Doctors on the day to day management of patients and obtain medical reports/ expected length of stay where indicated.
  • Ensure smooth discharge process and co-ordinate any necessary post-hospitalization/ step down facility care.
  • Revise reserves after discharge of member.
  • Collect feedback from admitted clients on quality and scope of service by the service provider.
  • Assist in carrying out verification and medical audit of claims/invoices before settlement.
  • Develop and maintain monthly database on admissions, large claims and extended length of stay.  
  • Respond to queries from clients, intermediaries and service providers.
  • Liaise with other medical underwriter for purposes of market surveys and development of new controls, standards and products.
  • Any other duty assigned by management.

SKILLS AND COMPETENCIES

  • Excellent communication and negotiation skills.
  • Excellent public relations and interpersonal relationship skills.
  • Extensive networking with SP and other medical insurers.
  • Excellent analytical and monitoring skills
  • Good IT skills in database management and office systems.
  • Good decision making in benefit utilization management.
  •  High levels of integrity and honesty

QUALIFICATIONS, KNOWLEDGE & EXPERIENCE 

  • Diploma or Degree in Nursing                      
  • Diploma in Insurance/ COP
  • Degree in Health systems Management/ Business management 
  • 1 years’ experience in clinical setting +1 years in insurance set up
     

  • Method of Application

    Interested and qualified? Go to Old Mutual Kenya on oldmutual.wd3.myworkdayjobs.com to apply

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