Registered Nurses Jobs in Athi River, Kenya
Registered Nurses Jobs in Athi River, Kenya
Job Description: Registered Nurses will be required to work on medical related projects as below stated
Perform Utilization Management (UM) reviews in accordance with mandated regulations. Maintains compliance with regulatory changes affecting UM.
Perform UM reviews (prospective/concurrent/retrospective) for inpatient and outpatient services according to the prescribed standards and client requirements and/or policies.
Review UM requests for services against established clinical review criteria, referring cases not meeting criteria to a physician reviewer or prescribed escalation protocol.
Adheres to Department of Labor, State, and company UM time frame requirements.
Coordinates physician reviewer referral as needed and follows up timely to obtain and deliver those results.
Tracks status of all UM in progress.
Releases UM determinations to claim stakeholders following client-established protocols.
Works closely with management team in the ongoing development and implementation of UM programs.
Certifies reviews that meet clinical review criteria/guidelines.
Adheres to quality standards and State UM guidelines.
Maintains all required UM review documentation in the UM software in a timely manner.
Serves as first level contact for customer complaint resolution.
Responds to inbound telephone calls pertaining to UM reviews in a timely manner, following client-established protocols
Processes customer calls consistent with program specified strategies and customer satisfaction measurements to include but not limited to proper answering procedure, e.g. opening and closing remarks
Maintains acceptable levels of performance including but not limited to attendance, adherence to protocols, customer courtesy, and all other productivity and efficiency targets and objectives.
Manages assigned workload within established performance standards.
Maintains confidentiality of all information, policies, and procedures as required by the Health Insurance Portability and Accountability Act (HIPAA) protocols.
Learns new methods and services as the job requires.
Advises supervisor of any potential problems as they become evident
Performs other duties as assigned or required
Required Qualifications, Experience and Skills
Must be a BScN – Bachelor of Science in Nursing or KRCHN – Kenya Registered Community Health Nurse
Must have must have completed the Nursing Council License Exam and have an active and current RN Practice License and Registration Certificate from the Nursing Council of Kenya (NCK).
Must have relevant experience of 2+ years
For OTHER HEALTH SCIENCES PROFESSIONALS:
a Registered Professional in their respective field.
Must have an active, current and unrestricted relevant Professional license issued by the Kenya Medical Practitioners and Dentists Council (KMPDC), have relevant years of clinical BPO experience in any of or similar Must domains of Utilization Management, Case Management, Disease Management, Wellness, Medical Coding and Billing, Pharmacy Benefits Management in any of the industry sectors of Workers’ Compensation; Commercial Managed Care; Health, Disability, Life, Property and Casualty Insurance; Accountable Care Organizations (ACO’s) or any other sector wherein the work performed is related to the use of clinical knowledge and skills.
Knowledge of nursing principles, techniques, and procedures for the care of patients.
Knowledge of medical terminology, anatomy, physiology and concepts of disease
Makes sound clinical decisions in a timely manner
Can potentially define whether a person qualifies for insurance medical cover or is eligible for Medical benefit etc.
Must be proficient in utilizing relevant technologies and system applications commonly used in Health Care Management
Work in an intensive, fast-paced environment with minimal supervision
Ability to stay organized and interact well with others in any situation
Provide daily updates to Manager of Utilization Management for review
Must be willing to work rotational shifts with adherence to schedule, including evenings, weekends and overtime as necessary
Must be detail oriented and possess good organizational skills
Must have effective written and oral communication skills and be able to maintain confidentiality
Must have excellent interpersonal skills and team oriented to work in a high stress environment
Able to handle multiple tasks and shifting priorities
Ability to work on projects and meet deadlines
How to Apply
If you think you are the one we are looking for, we invite you to send your applications to
email@example.com not later than 20th January 2021.
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