Care Manager at Bristol Park Hospital

About the Role

Bristol Park Hospital in Nairobi, Kenya is seeking a qualified Care Manager to coordinate and manage patient care authorization, insurance liaison, and care continuity across our inpatient and outpatient services.

Key Responsibilities

• Coordinate all inpatient and outpatient pre-authorization requests, extensions, and undertakings with payers
• Ensure timely submission, follow-up, and approval of pre-authorizations and extensions within required turnaround times
• Liaise with insurers, brokers, patients, and internal clinical teams to provide timely communication and clarification
• Validate and manage undertakings, guarantee of payments, and financial exposures for admissions and specialized procedures
• Ensure accuracy, completeness, and compliance of documentation and medical reports required by payers
• Review service validity, membership, and benefit coverage against payer rules and clinical standards
• Maintain accurate and structured records of authorization activities, including high-value cases
• Coordinate inward and outward referrals, ensuring complete documentation and seamless continuity of care
• Monitor trends, generate reports (daily, weekly, monthly), and identify gaps for continuous improvement
• Support interdepartmental communication to enhance timely service flow and customer experience
• Conduct capacity building for staff on appropriate billing and care coordination
• Uphold compliance with regulatory, ethical, and care quality standards

Essential Qualifications & Experience

• Bachelor's Degree in Nursing, Clinical Medicine, or related healthcare field
• Minimum 3 years' experience in one or more of the following:
  • Care coordination / Case management
  • Utilization review
  • Medical insurance liaison
  • Claims processing
  • Admission and discharge management
• Experience working with insurers, payers, and TPAs
• Proven ability to interpret medical documentation, reports, and treatment plans

Desirable Qualifications

• Certification in Case Management, Utilization Management, or Health Insurance
• Experience in referral coordination or clinical pathways