Case Management Nurse - FT-1 at Old Mutual Kenya

Job Description

• 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.

QUALIFICATIONS, KNOWLEDGE & EXPERIENCE 

• Diploma or Degree in Nursing                      
• Diploma in Insurance/ COP 
• Degree in Health systems Management/ Business management  
• 3 years’ experience in clinical setting +2 years in insurance set up
• Provides a service as a temporary employee covering many fields

Closing: 14 March 2023