Regina Maina
Nurse Caremanager
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About
I am a nurse by profession. Been a nurse caremanager for over 7 years. I am very passionate in achieving the set goals. I am a team player.
Experience
Care Manager, Healthcare Department at Minet Kenya Insurance Brokers Limited
Period July 2019 – Date
- CASE MANAGEMENT o Daily hospital visits and patients’ reviews.
o Costs negotiations with providers for hospitalised members.
o Seamless facilitation of evacuations.
o Prompt solution- based updates to all clients on exceptional cases.
o Management of home care patients and providers.
- CUSTOMER SERVICE.
o Ensure seamless flow of work between myself and the client.
County Care Manager, Narok County at Minet Kenya Insurance Brokers Limited
Period – Jan 2019 to July 2019
- CASE MANAGEMENT o Daily hospital visits and patients’ reviews.
o Costs negotiations with providers for hospitalised members.
o Seamless facilitation of evacuations.
o Prompt solution- based updates to all clients on exceptionacases.
o Management of home care patients and providers.
- CUSTOMER SERVICE.
o Ensure seamless flow of work between myself and the client.
Care Manager, TSC Call Centre at Minet Kenya Insurance Brokers Limited
Period- July 2015 to Dec 2018
o Executing activities of the Centre which include: o Receiving pre-authorizations from hospitals and other care points.
o Scrutinizing the pre-authorization forms to ensure compliance with insurance policy requirements for claim.
o Ensuring the clients receive quality healthcare at a reasonable cost. o Effective management of employees benefit to avoid wastage and misuse.
o Issuing letters of undertaking for inpatients, outpatients, day-care, dental and optical services. o Handling enquiries and advising clients and service providers on membership, cover limits and balances.
o Booking doctor appointments for clients and organizing referrals and evacuations. o Respond to queries, telephone calls, and letters from the various providers regarding different schemes.
o Coordinating with claims, Customer care, and Accounting and Business development units to ensure client and service provider satisfaction.
o Hospital visits to check on patients’ care and management o Supervision of team members work allocation, appraisals, and instilling teamwork o Appointment of service providers as per scheme needs, discussing with the team/client the need to add service providers.
o Service provider education on scheme rules and policy issues.
o Resolving various client issues and queries that relate to claims.
o Analysing and interpreting claims experience and giving suggestions for interventions if need be for example cost cutting measures, need for health talk.
o Organizing for overseas treatment or evacuations for clients as need arises.
o Maintain excellent relationship with the service providers.
o Review existing contracts and negotiate with service providers for fair rates/discounts.
o Preparation and execution of working schedules to ensure that the call centre is manned 24 hours o Overseas arrangement and credit facilitation for member’s requiring treatment abroad.
o Assist the Managers in charge in timely appraisal of staff members.
Registered Nurse (RN) Afyamax Medical and Dental Clinic- Utawala, Nairobi, Period- August 2014-June 2015
- Nursing services e.g. dressing of wounds, dispensing of medicine, BP, temperature check.
- Giving CME to the staffs to keep them up to date with the new findings in health care.
- Attend to medical and surgical emergencies.
- Implement, evaluate and document all patient care interventions and responses.
- Specialize in maintaining a high level of patient satisfaction through excellent customer service.
- Initiate and maintain multi-disciplinary treatment plans, and make sure that all elements are reviewed and revised as required by departmental policy and regulatory standards.
- Assess patient/family learning needs, as well as providing and documenting psycho-educational interventions by utilizing a variety of therapeutic programming modalities.
Education
EDUCATION BACKGROUND
HIGH SCHOOL EDUCATION
- Karoti Girls High School (2006-2009)
Kenya Certificate of Secondary Education
Grade – C (Plain)
PROFESSIONAL EDUCATION
- Sept 2010 - Feb 2014:
Kenya Registered Community Health Nurse at Kenya Medical Training College.
PROFESSIONAL AFFILIATIONS
- Nursing Council of Kenya
