Care Manager (Field) Job in Kenya

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Care Manager (Field) Job in Kenya

Job Ref. No. JHIL050

Position: Care Manager (Field)

Jubilee Insurance was established in August 1937, as the first locally incorporated Insurance Company based in Mombasa. Jubilee Insurance has spread its sphere of influence throughout the region to become the largest Composite insurer in East Africa, handling Life, Pensions, General and Medical Insurance. Today, Jubilee is the number one insurer in East Africa with over 450,000 clients. Jubilee Insurance has a network of offices in Kenya, Uganda, Tanzania, Burundi and Mauritius. It is the only ISO certified insurance group listed on the three East Africa stock exchanges – The Nairobi Securities Exchange (NSE), Dar es Salaam Stock Exchange and Uganda Securities Exchange.


Its regional offices are highly rated on leadership, quality and risk management and have been awarded an AA-in Kenya and Uganda, and an A+ in Tanzania. For more information, visit www.JubileeInsurance.com

We currently have an exciting career opportunity for Care Manager within Jubilee Health Insurance Limited. The position holder will report to the Assistant Manager, Care Management will be based at Head Office in Nairobi.

Role Purpose

Care Management, visiting patients at the various service providers, providing professional guidance on policy matters where requested, ensuring comfort and assistance of patient by the service provider, and communicating with providers, clients and brokers on a timely basis for any rejections or relevant concerns

Main Responsibilities

  • Obtaining daily reports of admissions in the various service providers.
  • Broker/customer communications by communicating as necessary admission claim decisions on a timely basis.
  • Care Management – Through due diligence, ensuring undertakings are issued in line with the policy provisions. Likewise for declines, ensuring that the decisions are accurate.
  • Visiting of patients at the various service providers, obtaining details of patients to confirm that admitted members are the eligible policy holders/ dependents.
  • Confirming that the treatment the member is given is covered by the policy purchased.
  • Ensuring that the medical reports in the hospital are accurate and reflective of what is provided to the insurer and confirm what the member understands or communicates.
  • Ensuring proper care and treatment of patient within acceptable protocols without wastage by member/ provider.
  • Reviewing medical pre-authorizations for compliance with applicable policy guidelines and giving guidance to the other care management team on any information collected during the visits to the hospitals.
  • Interacting with clients, brokers and clinicians as needed, to resolve problems in a manner that is legal, ethical, and consistent with the principles of the policy.
  • Obtaining medical information from providers with written correspondence if necessary.
  • Participating in care management meetings.
  • Checking and confirming membership validity and benefits (from the scheme benefits file).
  • Handling of coverage enquiries with brokers, providers, members etc.
  • Vetting and confirming validity of the service given by the service provider in relation to the benefits covered, treatment given, adherence to provider panel rules and cost of treatment.
  • Obtaining additional required information on claims from providers, brokers, or clients.
  • Liaising with our underwriting section on scope of cover for various schemes.
  • Assisting in conducting provider audits wherever necessary.
  • Client presentations and member education on wise utilization & risk management.
  • Managing the 24-hour emergency helpline.

Functional Skills

  • Performance reporting and management
  • Health Benefits Plan Management
  • Intelligence and Business Development skills
  • Policy Interpretation
  • Customer Service

Key Competencies

  • Visionary Leadership
  • Market Awareness
  • Customer Focus
  • Continuous Innovation
  • Ownership & Commitment
  • Team Spirit

Qualifications

  • Degree/ Diploma holders preferably in clinical studies (nursing, clinical medicine)
  • Basic understanding of the concepts of insurance
  • Proficient in the use of Microsoft office suite and packages

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 22nd November 2022

Only shortlisted candidates will be contacted.