Job Description
Medical Jobs. Bristol Park Hospital Jobs
We are seeking to recruit a highly skilled, experienced, and dynamic professional to join our team as Care Manager.
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.
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Qualifications & Experience
Essential
- Bachelor’s Degree in Nursing, Clinical Medicine, or related healthcare field.
- Minimum 3 years’ experience in:
- 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
- Certification in Case Management, Utilization Management, or Health Insurance.
- Experience in referral coordination or clinical pathways.
- Experience in a multi-specialty hospital environment.
- Experience using HIS/EMR authorization modules.
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How to Apply
Interested and qualified candidates are invited to send their application letter, detailed CV, and academic certificates to humanresource@bristolpark.or.ke, clearly indicating the subject line as CARE MANAGER, on or before 19th December, 2025.
Only shortlisted candidates will be contacted.
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