CASE MANAGER JOB JUBILEE INSURANCE
| Location | NAIROBI, Kenya |
| Date Posted | March 28, 2025 |
| Category |
Management
|
| Job Type |
Full-time
|
| Currency | KES |
Description
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.
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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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How to Apply
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.
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Contact
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3rd Floor, Mayfair Suites, Westlands, Nairobi
- Mobile: Employers Only – 0797 452 211; 0796 630 043
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