Consultant Care Management

About the role

Consultant Care Management oversees healthcare claims, pre‑authorizations, and patient care coordination. The role requires a Healthcare/Nursing degree and at least one year of medical care management experience. It is a full‑time position based in Nairobi, Kenya.

Key responsibilities

• Manning calls on the 24‑hour medical emergencies help lines.
• Facilitate approval and authorisation for Emergency Inpatient hospitalisation, e.g., post road traffic accidents from the insurance companies/underwriters.
• Outpatient treatment authorisation (off smart/ no card).
• Facilitate evacuation processes to ensure favourable outcomes and reasonable charge to clients.
• Pre‑authorization request processing and hospital procedure booking including maternity and theatre procedure bookings.
• Liaising with insurance companies in the process of undertaking pre‑authorizations.
• Provider panel management – ensuring required facilities are onboarded and favourable relationships are maintained.
• Advocating for clients and negotiating borderline claims.
• Support with overseas referral and offering dedicated services to clients at their premises.
• Reporting – provide data reports collected from various monitoring tools assigned to the role (weekly and/or monthly reports).
• Trend analysis – hospital charges, cost of various packages, etc.
• Facilitation of admission and discharge processes for patients by securing all necessary documents and ensuring minimal participation by the patient.
• Facilitation of special care for admitted patients, e.g., haircuts for executive clients at the bedside or flowers.
• Issuing Zamara gift packs – diapers, branded get‑well/birth congratulations to admitted patients.

Required profile

• A Diploma in Nursing Sciences/Clinical medicine.
• Minimum of one (1) year working in a hospital set‑up, health facility, or medical insurance care department.
• General understanding of the insurance industry is an added advantage.
• Capacity to build relationships.
• Business etiquette.
• Excellent interpersonal and customer service skills.
• Team player.
• Problem‑solving skills.
• Self‑driven.
• Flexible to train.