Care Manager at Avenue Healthcare

Mission:

To provide high-quality care that exceeds our clients’ expectations.

Key Responsibilities:

• Conduct daily in-patient rounds of the specific scheme beneficiaries admitted in the hospital.
• To ensure timely and appropriate admission, diagnosis, and treatment, care of patients and advise the hospital and the corporate accordingly.
• Ensure only authentic pre-authorizations are issued for clients seeking medical services in collaboration with the clinical medical team.
• Draw monthly reports for specific corporate clients inclusive of trends, analysis, market intelligence for improved business development.
• Liaise daily with other concerned units especially credit control and clinical department to seek amicable solutions to problems related to our billing and invoicing system.
• Conduct a regular review of the case process to identify gaps to enhance profitability as well as efficiency and effectiveness in the case management process.
• Enhance customer experience – establish and maintain good relationships with external and internal stakeholders such as underwriters, brokers, agents, and policyholders.
• Source, analyze and provide relevant information to the management for further decision-making.
• Support development of a preventative care program through health talks, wellness, that is a key value proposition to the hospital business chronic disease management program.
• Prepare the business reports on a daily or weekly basis as and when need be.
• Ensure incidents are documented by respective staff and discussed with the head of department at all times.
• Attend inter-phasing departmental meetings and convene meetings every fortnight to identify gaps in care coordination in order to improve services.
• Collaborate and coordinate with other departments, Consultants and other Clinicians to improve overall health service delivery in the department.
• Conduct continuous impact assessments and identified the most appropriate strategies to bridge established gaps in order to enhance efficiency in service delivery.
• Induction of new staff working in inter phasing departments as per the departmental/unit procedure manuals.
• Continuously improve on the hospital business NPS.
• Any other duty as assigned by the supervisor in line with the job description.

Person Specification:

• A BScN in nursing and administrative training
• Valid Kenyan nursing practice license.
• 3 years proven experience as a care manager.
• In-depth knowledge of health and safety guidelines and procedures
• Extensive knowledge of insurance policies
• Knowledge of legal regulations and best practices in healthcare
• Excellent knowledge of emergency care
• Excellent interpersonal and communication skills