Care Manager
AI job insight
Afia Concept Claims Settling Agency (ACS) is hiring a full-time Care Manager in Nairobi to coordinate member care, assess clinical needs and manage utilization. The role includes pre-authorisation adjudication, medical-cost negotiation and clinically safe transitions to cost-effective care settings. Candidates should be clinically trained, ideally registered nurses or clinicians, with two years of experience.
- Full-time medical and healthcare role based in Nairobi.
- Requires 2 years of experience and a degree, diploma or professional certificate.
- Coordinates clinical assessments, care plans, admissions, referrals and discharges.
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Afia Concept Claims Settling Agency (ACS) is hiring a full-time Care Manager in Nairobi to coordinate member care, assess clinical needs and manage utilization. The role includes pre-authorisation adjudication, medical-cost negotiation and clinically safe transitions to cost-effective care settings. Candidates should be clinically trained, ideally registered nurses or clinicians, with two years of experience.
- Full-time medical and healthcare role based in Nairobi.
- Requires 2 years of experience and a degree, diploma or professional certificate.
- Coordinates clinical assessments, care plans, admissions, referrals and discharges.
- Reviews treatment plans and supports cost-effective utilization decisions.
- ACS warns candidates never to pay for notarisation, certificates or assessments.
AI job guide
Use this guide to check salary signals, requirements, documents, application steps and safety before you apply.
AI salary guide
Source salary availableThe source lists Never pay for any notarisation, certificate or assessment as part of any recruitment process. Confirm the final pay, benefits, contract terms and allowances directly with the employer before accepting an offer.
Can you qualify for this role?
- Required2+ years of relevant experienceThe job post includes a minimum experience signal.
- RequiredEducation or certification mentioned in the postThe captured text mentions education, a diploma, certificate, or licence.
- PreferredPractical evidence in call_center, internship, entregadorThe tags and summary point to skills connected with this role.
- RequiredAvailability to work in NairobiThe vacancy is associated with this location.
- UnclearComfort with the Full Time contract termsConfirm hours, duration, probation and benefits at the original source.
Documents to prepare
- Likely requiredUpdated CV
- Role specificCover letter or short employer message
- OptionalProfessional references
- Role specificAcademic or professional certificates
- VerifyLicence, permit or professional registration
- VerifyID or passport only after verifying the employer
Application tips for this job
- Place your strongest Care Manager evidence in the first half of your CV.
- In your cover letter or employer message, connect your experience to Afia Concept Claims Settling Agency (ACS) and the role in Nairobi.
- Add concrete examples related to call_center, internship, entregador, ideally with measurable outcomes or clear responsibilities.
- Follow the instructions from MyJobMag Kenya; avoid sending documents to unofficial contacts or copied links.
- Confirm the deadline, interview location and employer contact before sharing personal documents.
- Prepare a polite question about pay, benefits and contract terms for later interview stages.
Source and safety check
- MyJobMag Kenya
- Original source link available
- Application method is clear
- Deadline not specified
- No major risk signal was detected in the captured text.
Never pay for interviews, shortlisting, medical checks, uniforms, or job placement. Confirm every application at the original source before sharing personal documents. Report suspicious listing.
Interview preparation
- What experience makes you a strong fit for this Care Manager role in call_center, internship?
- How have you handled responsibilities similar to those in this job post?
- Are you available to work in Nairobi under the listed contract or schedule?
- Prepare examples with clear responsibilities, tools used and measurable outcomes.
- Review the source and research Afia Concept Claims Settling Agency (ACS) before the interview.
Ask what the first priorities will be in the role and how success will be measured.
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Original source description
Never pay for any notarisation, certificate or assessment as part of any recruitment process. When in doubt,
contact us
Afia Concept Claims Settling Agency (ACS) is a forward-thinking healthcare consulting firm operating in East Africa, with headquarters in Nairobi, Kenya. Established to bridge the gap between healthcare infrastructure and accessible, high-quality services, ACS offers end-to-end solutions in healthcare facility design, health financing advisory, digital health, and operational management.
View All Jobs at Afia Concept Claims Settling Agency (ACS)
Care Manager
Job Type: Full Time
Qualifications
- BA/BSc/HND
- ,
- Diploma
- ,
- Professional Certificate
- Bachelor's Degree or Diploma in Nursing, Clinical Medicine, Medicine, Pharmacy or a related healthcare field.
- Valid professional registration and licensing where applicable.
- Added Advantage
- Professional qualification in AIIK, ACII, or Certificate in Insurance.
- Formal training in customer experience or call centre operations.
- Knowledge of medical scheme operations, SLAs, and healthcare provider management.
- Understanding of ISO Quality Standards and Data Protection Act compliance.
Experience
2 years
Location: Nairobi
Job Field: Medical / Healthcare
Role Purpose
The Care Manager is a clinically trained professional at the heart of ACS's medical operations function. The role carries three interconnected responsibilities: adjudicating pre-authorizations with speed and clinical accuracy, negotiating medical costs with healthcare providers during active admissions and service delivery, and providing sound clinical guidance to members navigating the healthcare system.
A particularly critical aspect of this role is the ability to step down care — identifying situations where a member can receive equivalent quality of treatment at a more cost-effective facility or care setting, and facilitating that transition in a way that is clinically safe, member-centred, and clearly communicated. The Care Manager must balance advocacy for the member's health outcomes with stewardship of scheme sustainability.
The ideal candidate is a clinically confident, commercially aware healthcare professional — typically a registered nurse or clinician with managed care experience — who can make sound, defensible clinical decisions under time pressure while maintaining strong relationships with providers, members, and internal teams.
Minimum of 2 years' experience in case management, utilization management, clinical care, managed care, medical insurance, or healthcare administration.
Experience in a medical insurance, TPA, healthcare management, or managed care environment is preferred.
Knowledge of healthcare benefits, pre-authorizations, and clinical protocols.
Check how your CV matches this job
Method of Application
- Interested and qualified? Go to
- Afia Concept Claims Settling Agency (ACS) on www.acs.co.ke
- to apply
- Build your CV for free.
- Download in different templates.
Key Accountabilities
- Care Coordination & Case Management
- Coordinate and manage care plans for assigned members.
- Conduct clinical assessments and evaluate members' healthcare needs.
- Monitor admissions, ongoing treatment, referrals, and discharge processes.
- Facilitate continuity of care across healthcare providers and service points.
- Ensure timely escalation of critical and emergency cases.
- Utilization Management
- Review treatment plans to ensure appropriateness, quality, and cost-effectiveness.
- Facilitate pre-authorizations and care approvals in accordance with clinical guidelines.
- Monitor healthcare utilization and identify opportunities for cost containment.
- Support interventions aimed at reducing unnecessary admissions and readmissions.
- Provider & Stakeholder Engagement
- Liaise with healthcare providers to coordinate member care and treatment plans.
- Collaborate with internal teams to ensure seamless service delivery.
- Participate in provider engagements, case reviews, and clinical discussions.
- Foster positive relationships with members, providers, and other stakeholders.
- Chronic Disease & Wellness Management
- Monitor high-cost, chronic, and complex medical cases.
- Support disease management and wellness initiatives.
- Promote preventive healthcare and member education programs.
- Guide members on available healthcare resources and treatment options.
- Member Advocacy & Experience
- Act as an advocate for members throughout their healthcare journey.
- Provide guidance on benefit utilization and access to care.
- Address member concerns and facilitate timely resolution of service issues.
- Support initiatives aimed at improving member satisfaction and outcomes.
- Clinical Quality & Compliance
- Ensure adherence to clinical protocols, policies, and regulatory requirements.
- Participate in clinical audits, quality reviews, and risk management activities.
- Monitor quality indicators and recommend improvement initiatives.
- Support implementation of evidence-based clinical practices.
- Reporting & Documentation
- Maintain accurate and up-to-date clinical records and case documentation.
- Prepare care management, utilization, and case review reports.
- Track and report on key care management metrics and outcomes.
- Ensure confidentiality and proper management of member information.
- Key Performance Indicators
- Member Care Coordination
- Quality of Clinical Outcomes
- Case Management Effectiveness
- Timeliness of Pre-Authorizations
- Member Satisfaction
- Care Plan Compliance
- Hospitalization and Readmission Management
- Utilization Management Effectiveness