Role Overview
Absa Bank Limited, through its subsidiary First Assurance Kenya, is seeking a Manager for Case Management & Provider Partnerships. This role is responsible for leading and overseeing Care Management operations, including inpatient preauthorizations, utilization management, and clinical case reviews. The successful candidate will ensure high-quality, timely, and cost-effective healthcare delivery while developing and managing strategic provider partnerships. This includes optimizing the provider network, negotiating cost structures, driving value-based care initiatives, and ensuring sustainable cost control and operational excellence.
Key Responsibilities
Strategic Leadership & Provider Partnerships
- Develop and implement strategic plans for Care/Case Management and Provider Partnerships aligned with medical business objectives.
- Design and execute provider network strategies ensuring quality, accessibility, cost-efficiency, and geographic coverage.
- Lead strategic engagement with hospitals, specialists, and healthcare facilities to establish long-term partnerships.
- Drive negotiation and contracting of pre-agreed rates, discounts, packages, and fixed-cost models.
- Identify and implement value-based care initiatives and innovative reimbursement models.
- Monitor industry trends and analyze provider performance data to identify cost drivers and optimization opportunities.
- Prepare periodic executive reports on case management outcomes and network adequacy.
Operations Management - Case Management
- Lead daily case management operations to ensure efficient, high-quality service delivery.
- Oversee clinical case reviews to confirm medical necessity and policy alignment.
- Monitor admission controls, including claim reserves, authorized costs, and length of stay.
- Drive cost optimization through utilization management and proactive bill negotiation.
- Manage complex and active cases, including emergency evacuations and international transfers.
- Coordinate with Provider Relations, contact centers, and scheme administrators for service continuity.
Operations Management - Provider Partnerships
- Lead provider onboarding and credentialing oversight with robust due diligence.
- Drive performance management through scorecards tracking quality, cost efficiency, and SLA compliance.
- Strengthen partnerships through regular engagement meetings and collaborative initiatives to reduce avoidable admissions.
- Ensure contract and tariff compliance, including oversight of dispute resolution.
People Management
- Lead, mentor, and develop a high-performing team of medical insurance professionals.
- Determine people management strategies focusing on talent management, development, and retention.
- Review workforce plans and implement performance-based appraisals in line with departmental KPIs.
Risk Management
- Identify and mitigate operational, financial, clinical, and reputational risks.
- Ensure strict adherence to healthcare regulations, insurance guidelines, and ethical standards.
- Implement internal controls to prevent fraud, waste, and abuse.
- Collaborate with Legal and Compliance teams on complex cases and regulatory matters.
Qualifications and Requirements
- Bachelor’s degree in Nursing, Clinical Medicine, or a related medical field.
- A Diploma in Insurance is an added advantage.
- Minimum of 7 years’ experience in clinical operations within the health insurance sector.
- At least 3 years of experience in a supervisory or leadership role.
- Relevant professional qualification.
- Must be a member of a professional body in good standing.
- Note: Diploma holders with strong experience may also be considered.
How to Apply
Qualified candidates are invited to apply online through the official Absa recruitment portal. Please follow the link provided to the application page on the Absa Workday site.
