Care Navigator at Jubilee Insurance

Job Reference Number: JHIL135
Location: Nairobi
Application Deadline: 13th December 2024

About Jubilee Insurance:

Founded in 1937 as the first locally incorporated insurance company in Mombasa, Jubilee Insurance is now the largest composite insurer in East Africa, offering Life, Pensions, General, and Medical Insurance. With a client base of over 1.9 million, Jubilee operates in Kenya, Uganda, Tanzania, and Burundi, and is the only ISO-certified insurance group listed on the three East African stock exchanges. For more information, visit www.JubileeInsurance.com.

Role Purpose:

The Care Navigator will report to the Assistant Manager, Care Navigation and will be based at the Head Office in Nairobi. The primary responsibility is to guide assigned members and schemes, offering professional support on policy matters, ensuring quality and cost-effective services, and maintaining communication with providers, clients, and brokers regarding rejections or concerns.

Key Responsibilities:

Strategy Development:

• Program Improvement: Identify areas for improvement in care navigation services and propose strategies to enhance program effectiveness.

• Healthcare Regulations: Stay informed about healthcare policies and regulations that could impact clients’ access to care.

• Policy Input: Provide input for developing insurance policies that align with care navigation objectives.

• Data Analysis: Analyze healthcare utilization data, costs, and outcomes to identify trends and improvement opportunities.

Operational:

• Monitoring Health Behaviors: Track the health-seeking behaviors of assigned members and take measures to improve population health.

• Wellness Programs: Enroll scheme members into appropriate wellness programs.

• Utilization Control: Monitor healthcare utilization and implement measures to control costs.

• Health Education: Organize and conduct health education sessions for members.

• Admission Monitoring: Obtain daily admission reports for members and ensure proper care during hospitalization.

• Care Navigation: Advise clients and navigate members to appropriate healthcare providers as needed.

• Medical Report Validation: Ensure that medical reports from hospitals align with patient management protocols.

• Client Interaction: Work with clients, brokers, and clinicians to resolve issues legally, ethically, and in line with policy terms.

Corporate Governance:

• Ethical Standards: Uphold ethical standards in all client, provider, and colleague interactions.

• Healthcare Laws Compliance: Stay informed and ensure compliance with healthcare-related laws and regulations.

• Confidentiality: Safeguard the confidentiality of client information and adhere to strict privacy standards.

• Risk Management: Identify risks related to care navigation activities and collaborate with departments to mitigate them.

Laws, Regulations, and Company Policies:

Stay updated on external laws (e.g., Anti-Money Laundering, Data Protection) and ensure strict adherence to both legal and company policies. Promote ethical behavior and encourage open communication about compliance concerns.

Key Skills and Competencies:

• Healthcare Knowledge: Strong understanding of healthcare systems, medical terminology, and insurance policies.

• Communication Skills: Excellent verbal and written communication skills for interacting with clients, providers, and colleagues.

• Empathy and Compassion: Ability to empathize with clients’ health concerns and provide compassionate support.

• Active Listening: Effectively listen to clients, understand their needs, and address concerns.

• Problem-Solving Skills: Strong problem-solving abilities to help clients overcome healthcare challenges.

• Organization and Time Management: Manage caseloads and appointments efficiently while maintaining attention to detail.

• Flexibility and Adaptability: Adapt to changing healthcare environments and client needs.

• Quality Improvement: Commitment to continuous improvement of care navigation services.

Academic Qualifications:

• Degree/Diploma in clinical studies

• Nursing qualification is an added advantage

• At least 2 years of experience in a clinical setting

• Basic understanding of insurance concepts

Relevant Experience:

• A minimum of 3 years of relevant experience with a solid understanding of medical insurance processes.

How to Apply:

If you are qualified and seeking an exciting new challenge, please send your application to Recruitment@jubileekenya.com, quoting the Job Reference Number and Position.

• Deadline: 13th December 2024

• Only shortlisted candidates will be contacted.

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