🩺 Care Manager – Kisumu (Healthcare/Insurance)
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 journeys: quick outpatient approvals, seamless inpatient admissions/discharges
- Manage pre-authorizations, discharges, claims reviews, and adjudication processes
- Monitor provider performance and recommend panel adjustments
- Oversee call center operations, ensuring timely resolution of cases
- Maintain traceable patient records for audit and compliance
- Coordinate with providers, insurers, and internal teams for efficient service delivery
- Train internal teams on clinical and claims processes
- Negotiate cost-saving treatment options with hospitals and insurers
- Develop and enforce case management protocols
- Support underwriting with expert medical input for complex cases
- Audit and advise on high-cost or long-stay treatment plans
- Assist in wellness education and client reporting
Qualifications:
- Degree in Nursing, Clinical Medicine, or related field
- Certification in Health Insurance or Case Management is an added advantage
- Advanced training in Utilization Review or Managed Care is preferred
Experience:
- Minimum 5 years in care management or medical underwriting roles
Skills & Competencies:
- Strong clinical and diagnostic knowledge
- Analytical with medical records and policy interpretation
- Insurance industry literacy including coding and compliance
- Excellent communication and stakeholder collaboration
- High attention to detail and process accuracy
- Leadership and staff development skills
- Effective problem-solving and resolution abilities
📍 Location:
Kisumu, Kenya
💼 How to Apply:
WhatsApp KisumuKulture for Inquiries
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