Case Management Nurse
Job TypeFull Time
Experience2 years
Job FieldMedical / Healthcare
Your time is now to be your exceptional best at Old Mutual!

Job Description


  • 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


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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.