Job Ref. No: JHIL163
Role Purpose
The Case Manager will be responsible for monitoring and managing the utilization of medical services to ensure appropriate and cost-effective care while maintaining quality standards; Conduct clinical reviews of cases, assess treatment efficacy, ensure adherence to best practices, and recommend adjustments when needed.
Key Responsibilities
Execute robust case management strategies aligned with the organization’s mission and objectives.
Identify opportunities for innovative interventions, process enhancements, and costeffective healthcare solutions.
Stay updated with industry trends, healthcare practices, and regulatory changes to inform strategic decision-making.
Monitor, analyse, and report on case management outcomes to drive continuous improvement.
Advocate on behalf of policyholders to ensure they receive necessary and appropriate healthcare services.
Address any barriers to care, such as communication issues or insurance-related concerns.
Maintain detailed and accurate records of assessments, care plans, and interactions with policyholders and healthcare providers.
Monitor the quality of healthcare services provided to policyholders.
Identify opportunities for improvement and work with healthcare providers to enhance care quality.
Work to manage healthcare costs by ensuring that care is appropriate, cost-effective, and aligned with policy coverage.
Evaluate active insurance cases to understand policy coverage, claim status, and the specific needs and concerns of policyholders.
Negotiation and Settlement; Engage in negotiation with medical providers to achieve equitable settlements of hospital bills when required.
Ensure strict compliance with healthcare regulations, insurance guidelines, and ethical standards within the Case Management function.
Collaborate with legal and compliance teams to address complex regulatory and legal issues related to case management.
Ensure all case management activities adhere to healthcare regulations, insurance policies, and ethical standards.
Key Skills and Competencies
Exceptional leadership and team management skills.
Strong analytical and critical-thinking abilities.
Effective communication and interpersonal skills.
Strategic vision and decision-making prowess.
Thorough understanding of healthcare regulations and insurance practices.
Clinical knowledge and medical expertise.
Academic & Professional Qualifications
Bachelor’s degree in nursing or clinical medicine, or a related field.
Relevant certifications in case management, healthcare management, or clinical specialties.
Relevant Experience
A minimum of two (2) years relevant working experience. Ideal candidates should possess a strong understanding of Medical Insurance.
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If you are qualified and seeking an exciting new challenge, please apply via Recruitment@jubileekenya.com quoting the Job Reference Number and Position by 2nd April 2025. Only shortlisted candidates will be contacted.
Apply via :
Recruitment@jubileekenya.com
