Case Manager

CarePay

Case Manager responsible for managing preauthorization requests and coordinating inpatient care at CarePay. Engaging healthcare providers and stakeholders to ensure quality care within the health insurance sector.

Posted 6/1/2026full-timeNairobi • 🇰🇪 KenyaMid-LevelSeniorWebsite

About the role

Key responsibilities & impact

Responsible for coordinating and managing inpatient and outpatient preauthorization requests in line with policy guidelines, clinical appropriateness, and cost containment objectives.
Ensure timely review and authorization of medical requests.
Effective follow-up of admitted members through hospital visits and phone calls.
Close monitoring of patient progress to support quality, medically necessary, and cost-effective care.
Oversee inpatient admissions from preauthorization through discharge, including reviewing interim bills, medical reports, treatment plans, and discharge summaries.
Engage providers, members, and internal stakeholders to facilitate timely care decisions, manage escalations, and promote positive clinical and financial outcomes.
Identify utilization trends, potential fraud, waste, and abuse indicators, and areas for process improvement.

Requirements

What you’ll need

Degree or Diploma in Nursing, Clinical Medicine, or another related health qualification from a recognized institution.
Valid registration with the relevant professional regulatory body in Kenya.
4 years experience in medical case management, utilization review, or claims assessment within the health insurance industry, hospital setting, or managed care environment.
Certificate in Insurance from an accredited institution (Mandatory).
Good understanding of health insurance operations, preauthorization processes, and benefit application.
Good knowledge of inpatient care pathways, treatment protocols, medical billing practices, and hospital workflows.
Understanding of private and public healthcare systems in Kenya.
Experience in reviewing medical reports, treatment plans, and hospital bills will be an added advantage.

Benefits

Comp & perks

Health insurance
Professional development opportunities

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

medical case managementutilization reviewclaims assessmentpreauthorization processesmedical billing practicestreatment protocolshospital workflowsreviewing medical reportsmonitoring patient progresscost containment

Soft Skills

coordinationmanagementeffective follow-upengagementcommunicationproblem-solvingprocess improvementstakeholder managementclinical decision-makingtimely care facilitation

Certifications

Certificate in Insurancevalid registration with professional regulatory body