Care Management Officer at Aga Khan University

Nairobi, , Kenya -

Full Time

Start Date

Immediate

Expiry Date

13 May, 26

Salary

0.0

Posted On

12 Feb, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Relationship Management, Business Development, Service Delivery, Utilization Review, Benefit Verification, Authorization, Patient Advocacy, Communication, EHR Systems, Data Reporting, Clinical Care Coordination, Financial Management, Problem Solving, Interpersonal Skills, Ethical Decision Making

Industry

Hospitals and Health Care

Description

Care Management Officer Division Marketing & Business Development Entity Aga Khan University Hospital, Nairobi Location Nairobi, Kenya Introduction Aga Khan University Hospital, Nairobi is a private not-for-profit teaching hospital that provides tertiary and secondary level healthcare services. It is the first hospital in East Africa to be accredited by the Joint Commission International from the USA. The University Hospital has been providing high quality care for the people of East Africa and beyond for over 60 years. Applications are invited from qualified candidates for the above position based in Nairobi Kenya. The position holder will report to the Manager – Marketing & Business Development, Aga Khan University Hospital Nairobi. Job Purpose To provide integrated hospital-based care management for corporate and insured patients by coordinating clinical care, client support, payer communication while serving as g as a liaison and coordinator to specific corporate payers And participating in formulating strategic plans for the future growth of AKUHN business. Key responsibilities Corporate Relationship and Business Support · Maintain strong relationships with Corporate Care Managers & TPA’s. · Conduct one-to-one engagement with the care managers. · Identify gaps in service delivery and give feedback to management. · Explore business development opportunities which the hospital can take advantage of. · Monitor & evaluate referrals from these corporate. Corporate Operational Guidelines · Coordinate smooth execution of corporate operational guidelines. Clinical Care, Coordination and Facilitation · Coordinate care for scheme beneficiaries across inpatient, outpatient and diagnostic s · Identifying high-risk patients (high cost, prolonged length of stay and re-admissions) · Liase with clinicians to ensure timely service delivery aligned to patient needs and cover limits. · Monitor the inpatient progress in the hospital. Utilization/Financial management. · Conduct utilization review for high cost and prolonged admissions · Verifying itemized bills on daily basis and coordinating the same with the corporate care managers. · Confirm benefits, limits and authorization to ensure appropriately and verify coverage and benefit with health insurer to ensure that the patient is appropriately billed. · Coordinating availability of required services. Advocacy Education Communication · Advocates for the patients under specific schemes for needed services and educate accordingly, based on their limited cover. · Coordinate communication between patients, clinicians, insurers and corporate partners. · Resolve issues arising from patients, families, clinicians and payers. Digital Health, Data & Reporting · Utilize hospital information systems to track admissions, LOS, Utilization and discharges. · Prepare periodic care management and utilization reports for management · Support data- driven decision making for service improvement Qualifications, Experience and Skills required: · Diploma/bachelor’s degree in nursing · Minimum 3 years nursing experience, both in acute / or critical care settings · Minimum 2 years Care Management within insurance or corporate healthcare · Minimum 3 years’ Hospital Care Management experience Technical & professional competencies · Hospital care coordination and utilization management · Knowledge of clinical pathways and insurance benefit structures · Understanding case-based costing added advantage · Proficiency in hospital EHR and digital health systems Personal characteristics & behaviors · Strong communication skills & interpersonal skills · Analytical and problem-solving ability · Team player with resilience and patience · Ethical decision making with high integrity

Responsibilities

The officer will provide integrated hospital-based care management for corporate and insured patients by coordinating clinical care, client support, and payer communication. Key duties include maintaining corporate relationships, monitoring service execution, and managing utilization and financial aspects of patient care.