Care Manager at Avenue Healthcare
2 weeks ago
Avenue Hospital was founded in 1995 for the purpose of managing the outpatient department at the Hospital, and to extend medical services to corporate clientele through an innovative concept of Managed Healthcare.
Mission:
To provide high-quality care that exceeds our clients’ expectations.
Key Responsibilities:
Conduct 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 underwriters, brokers, agents, and policyholders.
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 coordination in order to improve services.
Collaborate and coordinate 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.
Person Specification:
A BScN in nursing and administrative training
Valid Kenyan nursing practice license.
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
Excellent interpersonal and communication skills
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