CARE MANAGER

Position title

CARE MANAGERDescription

Bristol Park Hospital is a licensed healthcare provider that has been in operation for over 17 years,
** offering quality and affordable healthcare services
** in Nairobi, Kajiado, and Machakos counties. Guided by our “To be a world-class provider of quality, innovative, and accessible healthcare solutions,” we are committed to excellence in service delivery as well as patient care and safety.  We are seeking to recruit a highly skilled, experienced, and dynamic professional to join our team as Care Manager.

Responsibilities
** 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.

Qualifications
** 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.
*
* How to Apply

** Interested and qualified candidates are invited to send their application letter, detailed CV, and academic certificates to human resource.ke, clearly indicating the subject line as
** CARE MANAGER,
** on or before 19th December, 2025.  Only shortlisted candidates will be contacted.

Job Location
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