Case Management Nurse - FT-2

Date Posted: Jan. 23, 2023, 9:57 a.m.

Old Mutual

Job Description

Job Description

To control and manage medical benefit utilization through preauthorization and case management activities and ensure quality, appropriate cost effective care and good customer service

Pre-authorize scheduled and nonscheduled admissions within the set guidelines.

Negotiate/discuss professional fees as appropriate for each admission.

Set the appropriate parameters for each admission (claim reserve, initial authorized cost and duration).

Visit all admitted clients within Nairobi region and its environs

Liaise with Doctors on the day to day management of patients and obtain medical reports/ expected length of stay where indicated.

Ensure smooth discharge process and co-ordinate any necessary post-hospitalization/ step down facility care.

Revise reserves after discharge of member.

Collect feedback from admitted clients on quality and scope of service by the service provider.

Assist in carrying out verification and medical audit of claims/invoices before settlement.

Develop and maintain monthly database on admissions, large claims and extended length of stay.  

Respond to queries from clients, intermediaries and service providers.

Liaise with other medical underwriter for purposes of market surveys and development of new controls, standards and products.

Any other duty assigned by management.


Excellent communication and negotiation skills.

Excellent public relations and interpersonal relationship skills.

Extensive networking with SP and other medical insurers.

Excellent analytical and monitoring skills Good IT skills in database management and office systems.Good decision making in benefit utilization management.  

High levels of integrity and honesty


Degree in Health systems Management/ Business management

Diploma or Degree in Nursing                      

Diploma in Insurance/ COP

1 years’ experience in clinical setting or insurance set up (Medical Department)

How To Apply

Interested and qualified candidates should submit their applications to Old Mutual via their career portal using the link Old Mutual Careers

Apply for this Job Now

Related Jobs

Amref Health Africa

Clinical Officer

Amref Health Africa careers, Amref Health Africa salaries. 2024 Job vacancies at Amref Health Africa for Clinical Officer in Kenya. Apply today.

healthcare & medical Nairobi, Kenya Mar/04/2024
Avenue Healthcare


Avenue Healthcare careers, Avenue Healthcare salaries. 2024 Job vacancies at Avenue Healthcare for Nutritionist in Kenya. Apply today.

healthcare & medical Nairobi, Kenya Jan/23/2024
Ilara Health

Pharma Associate (Warehouse Management)

Ilara Health careers, Ilara Health salaries. 2023 Job vacancies at Ilara Health for Pharma Associate (Warehouse Management) in Kenya. Apply today.

healthcare & medical Nairobi, Kenya Nov/20/2023
Brites Management

Nurse - Kenol

Brites Management careers, Brites Management salaries. 2023 Job vacancies at Brites Management for Nurse - Kenol in Kenya. Apply today.

healthcare & medical Nairobi, Kenya Nov/16/2023