Care Manager Job Transnep Insurance Brokers
Care Manager Job. Medical Jobs in Kenya
Job Purpose:
Lead care management and utilization review functions, aligning medical decisions with underwriting principles, supporting pre-authorizations, ensuring quality outcomes, cost efficiency, and client satisfaction.
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Key Responsibilities:
- Ensure smooth patient journey in accessing care. Outpatient – quick turnaround on pre-authorizations and Inpatient smooth admission and discharge process
- Manage pre-authorization, discharge, case review, and claims adjudication
- Monitor healthcare provider performance; recommend panel adjustments
- Oversee call centre operations; ensure resolution and protocol compliance
- Maintain accurate patient records for traceability and audits
- Liaise with providers, insurers, clients, and internal teams for service coordination
- Train internal staff on claims, clinical data interpretation, and care protocols
- Implement cost management strategies including negotiations with insurers, hospitals, doctors and other stakeholders.
- Develop and update case management protocols; ensure industry compliance
- Evaluate and manage provider panel; negotiate terms and contracts
- Support underwriting with expert medical opinions on complex cases
- Audit high-cost/long-term cases; recommend treatment alternatives
- Contribute to client education with wellness guidelines and utilization reports
Qualifications:
- Degree in Nursing, Clinical Medicine, or related field
- Certification in Health Insurance or Case Management (preferred)
- Advanced training in Utilization Review or Managed Care
Experience:
Minimum 5 years in care management or medical underwriting
Skills & Competencies:
- Clinical proficiency; diagnostic and treatment standards
- Analytical acumen; medical records and coverage impact analysis
- Insurance literacy; policy and medical coding knowledge
- Communication and collaboration with stakeholders
- Detail-oriented; document accuracy and compliance
- Team leadership and capacity-building
- Problem-solving mindset; service and claims resolution
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