Case Management Officer Job Britam, Nairobi, Kenya
Job Purpose:
- Reporting to the Manager Clinicals, the role holder will be responsible for control and managing of the policy cycle through pre-authorization and case management, to ensure quality and cost effective care.
Key responsibilities:
- Set the appropriate parameters for each admission (claim reserve, initial authorized cost and duration).
- Interact with clients and service providers to ensure that the care is given within policy guidelines.
- Review medical reports and claims for compliance with set guidelines.
- Liaise with underwriters on scope of cover for the various schemes.
- Ensure that medical scheme members are attended to round the clock with support from 24 hour call centre.
- Poly-Pharmacy – discourage poly-pharmacy by diligent challenging of prescriptions and suggesting better alternatives.
- Generic substitution – Encourage use of generics where indicated as a method of reducing the organizations pharmaceutical expenditure.
- Delegated Authority: As per the approved Delegated Authority Matrix.
- Prepare periodic reports for management on medical claims.
- Ensure claims are processed within the stipulated time.
- Perform any other duties as may be assigned from time to time
Knowledge, experience and qualifications required:
- Diploma/Degree in Nursing or Diploma in clinical medicine or Diploma in Pharmacy.
- Understanding of insurance concepts.
- Professional qualification in FLMI, ACII and IIK would be an added advantage.
- 3-4 years’ experience in case management
How to Apply
🎯 Before You Apply For this Job.
This job will attract 1000+ applicants.
Many qualified professionals will miss out on getting shortlisted and interviews — not because they lack experience, but because their CV doesn’t clearly show how they fit this specific job.
🎯 Want to get an interview fast? Customize your CV specifically for this job.
Using the same CV for every application will not get you interviews.
Contact Rose our client service manager and together with our recruiters she will review your CV and show you exactly how to improve it for the job you are targeting. Click Here For Us To Customize Your CV For This Job Opportunity
Is your AI CV not getting you interviews? Click Here To Get A Professionally Written CV
⭐ 5-Star Reviews. Job Seeker Testimonials: Professionals Who Got Jobs Through Corporate Staffing
Since 2011, Kenyan professionals have trusted Corporate Staffing Services to help them secure employment with leading employers in Kenya and beyond. Read testimonials from candidates who have experienced our recruitment process firsthand and successfully gotten hired through our recruitment services.You Could Be Our Next Success Story. Read Success Stories From Professionals Who Landed Jobs Through Corporate Staffing
Jobs Managed by Our Recruitment Team
The vacancies below are managed directly by the Corporate Staffing recruitment team on behalf of our clients. Review the job advert, then submit your application through our recruitment team for consideration.
Browse Other Jobs Posted Today
Explore the latest job opportunities posted now. Apply early to maximize your chances, as many employers begin reviewing applications as soon as suitable candidates apply.