Case Management Nurse
Job TypeFull Time
Job FieldMedical / Healthcare
Your time is now to be your exceptional best at Old Mutual!
KEY TASKS & RESPONSIBILITIES
- Pre-authorize scheduled and emergency admissions within the defined guidelines.
- Determine the appropriate parameters for admission i.e. initial authorized cost and expected length of stay
- Negotiate professional fees as appropriate for each admission.
- Conduct hospital visits for admitted clients within the major towns
- Liaise with doctors on the day to day management of patients and obtain medical reports where indicated.
- Ensure smooth discharge process and coordinate any necessary post-hospitalization or stepdown care.
- Revise reserves after discharge of member.
- Collect feedback from admitted clients on quality and level of service by the providers
- Assist in verification and audit of inpatient claims prior to settlement
- Maintain relevant reports on admissions
- Promptly respond to queries from clients, intermediaries and providers
- Liaise with underwriting section for development of new products or benefits
- Proactively escalate any identified risks or risk events
- Any other duty assigned by management
Skills & Competencies
- Excellent communication and negotiation skills.
- Excellent interpersonal relationship skills.
- Extensive networking with SP and other medical insurers.
- Excellent analytical and monitoring skills
- Good decision making in benefit utilization management.
- High level of integrity and honesty
Qualifications, Knowledge & Experience
- Diploma/Bachelor in Nursing or Clinical Medicine
- Any insurance certification e.g. COP is an added advantage
- At least 2 years’ relevant experience within a health insurance
- At least 2 years’ experience in a busy hospital setting
- Skills and Experience
MODE OF APPLICATION
Click “APPLY FOR JOB” button above to apply for this job.
About Old Mutual South Africa
Old Mutual Kenya is based in Nairobi and is part of a larger group that offers solutions in long-term savings, asset management and investment. We offer solutions to individuals and corporates underpinned by our core values which are: Respect, Integrity, Accountability and Pushing beyond boundaries.