Care Manager at Avenue Healthcare

• To Monitor ongoing quality, productivity, efficiency and cost effectiveness of services and liaison person with third party payers.

• Conducts daily in patient rounds of the specific scheme beneficiaries admitted in the hospital. To ensure timely and appropriate admission, diagnosis, and treatment, care of patients and advise the hospital and the corporate accordingly.
• Ensure only authentic pre-authorizations are issued for clients seeking medical services in collaboration with the clinical medical team.
• Draw monthly reports for specific corporate clients inclusive of trends, analysis, market intelligence for improved business development
• Liaise daily with other concerned units especially credit control and clinical department to seek amicable solutions to problems related to our billing and invoicing system.
• Conduct a regular review of the case process to identify gaps to enhance profitability as well as efficiency and effectiveness in the case management process.
• Enhance customer experience - establish and maintain good relationships with external and internal stakeholders such as underwriter's, brokers, agents, and policy holders.
• Source, analyze and provide relevant information to the management for further decision making.
• Support development of a preventative care program through health talks, wellness, that is a key value proposition to the hospital business chronic disease management program.
• Prepare the business reports on a daily or weekly basis as and when need be.
• Ensure incidents are documented by respective staff and discussed with the head of department at all times.
• Attend inter-phasing departmental meetings and convene meetings every fortnight to identify gaps in care co-ordination in-order to improve services.
• Collaborate and co-ordinate with other departments, Consultants and other Clinicians to improve overall health service delivery in the department.
• Conduct continuous impact assessments and identified the most appropriate strategies to bridge established gaps in order to enhance efficiency in service delivery.
• Induction of new staff working in inter phasing departments as per the departmental/unit procedure manuals.
• Continuously improve on the hospital business NPS
• Any other duty as assigned by the supervisor in line with the job description.

• Kenya Registered Community Health Nurse or Kenya Registered
• Nurse / Midwife with 3 years' experience and above or other relevant qualification
• Certificate in computer application skills from a recognized institution.
• Valid Kenyan nursing practice license.
• Up to date BLS certificate
• 3 years proven experience as a care manager
• In-depth knowledge of health and safety guidelines and procedures
• Extensive knowledge of insurance policies
• Knowledge of legal regulations and best practices in healthcare
• Excellent knowledge of emergency care

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