The Care Management Officer is responsible for providing integrated hospital-based care management for corporate and insured patients. This involves coordinating clinical care, client support, and payer communication while serving as a liaison for specific corporate payers. The role also contributes to the formulation of strategic plans for the future growth of Aga Khan University Hospital, Nairobi (AKUHN).
Key Responsibilities
Corporate Relationship and Business Support
Maintain strong relationships with Corporate Care Managers and Third-Party Administrators (TPAs).
Conduct one-to-one engagement with care managers.
Identify gaps in service delivery and provide feedback to management.
Explore business development opportunities to drive hospital growth.
Monitor and evaluate referrals from corporate partners.
Corporate Operational Guidelines
Coordinate the smooth execution of corporate operational guidelines.
Clinical Care, Coordination, and Facilitation
Coordinate care for scheme beneficiaries across inpatient, outpatient, and diagnostic services.
Identify high-risk patients (high cost, prolonged length of stay, and re-admissions).
Liaise with clinicians to ensure timely service delivery aligned with patient needs and coverage limits.
Monitor inpatient progress within the hospital.
Utilization and Financial Management
Conduct utilization reviews for high-cost and prolonged admissions.
Verify itemized bills daily and coordinate with corporate care managers.
Confirm benefits, limits, and authorizations to ensure appropriate billing and coverage verification.
Coordinate the availability of required services.
Advocacy, Education, and Communication
Advocate for patients under specific schemes for needed services and provide education regarding limited cover.
Coordinate communication between patients, clinicians, insurers, and corporate partners.
Resolve issues arising from patients, families, clinicians, and payers.
Digital Health, Data, and Reporting
Utilize hospital information systems (EHR) to track admissions, length of stay (LOS), utilization, and discharges.
Prepare periodic care management and utilization reports for management.
Support data-driven decision-making for service improvement.
Requirements
Education: Diploma or Bachelor’s degree in Nursing.
Nursing Experience: Minimum 3 years of nursing experience in acute or critical care settings.
Specific Experience: Minimum 2 years of Care Management within insurance or corporate healthcare and minimum 3 years of Hospital Care Management experience.
Technical Competencies:
Knowledge of clinical pathways and insurance benefit structures.
Proficiency in hospital EHR and digital health systems.
Understanding of case-based costing is an added advantage.
Soft Skills: Strong communication and interpersonal skills, analytical and problem-solving ability, resilience, patience, and high ethical integrity.
How to Apply
Interested and qualified candidates should apply online via the Aga Khan University Hospital career portal (aku.taleo.net) through the following application link: https://www.myjobmag.co.ke/apply-now/1150257 on or before February 25, 2026.
How to Apply
Interested and qualified candidates should apply online by visiting the application link: https://www.myjobmag.co.ke/apply-now/1150257. This link will redirect you to the Aga Khan University Hospital recruitment portal on aku.taleo.net. Ensure your application is submitted before the deadline of February 25, 2026.
