Case Management Assistant

Role Overview

This position exists to keep patient care moving smoothly behind the scenes, bridging the gap between clinical teams, patients, payers, and administrative systems. Day to day, you will track treatment plans, verify insurance coverage, coordinate discharges or referrals, and make sure every step of the care journey is documented and communicated clearly. The work directly impacts patient outcomes and the hospital’s operational efficiency, so your attention to detail helps prevent delays, claim rejections, and miscommunication.

Key Responsibilities

• Review and monitor active patient cases to ensure treatment plans align with approved medical protocols and insurance benefits.
• Coordinate with doctors, nurses, and allied health professionals to gather clinical updates and revise care plans as patient conditions change.
• Serve as the main point of contact for patients and families, explaining care options, admission procedures, and discharge instructions in plain language.
• Liaise with insurance companies and third-party payers to obtain pre-authorizations, verify coverage limits, and resolve any disputes or documentation gaps.
• Maintain accurate patient records within the hospital management information system, including case notes, referral letters, and claims-related documentation.
• Identify and escalate any barriers to timely care, such as missing lab results, bed availability issues, or pending approvals, and follow up until resolved.
• Assist with utilization reviews by flagging cases that exceed expected length of stay or require additional clinical justification.
• Support the case management team during multidisciplinary meetings by preparing summaries, tracking action items, and recording follow-up activities.

Requirements & Qualifications

• Diploma or Bachelor’s degree in Nursing from a recognized institution, with current registration and licensure with the Nursing Council of Kenya.
• Mandatory membership with CMAKE, with proof of active status.
• Prior clinical or administrative experience in a hospital, clinic, or insurance setting is strongly preferred, typically one to two years.
• Additional certification or short courses in Case Management, Utilization Management, Healthcare Administration, or a related discipline will be considered an advantage.
• Practical training in medical insurance processes, pre-authorization workflows, and claims management is an added advantage.
• Current Basic Life Support (BLS) certification is preferred.
• Solid working knowledge of hospital billing systems and Health Management Information Systems (HMIS).
• Intermediate proficiency in Microsoft Office products, especially Excel, Word, and Outlook, with the ability to produce clear reports and track data accurately.