JOSEPH KAPOLON

Oversee inpatient and outpatient case management, including preauthorization review, admission management, claims assessment, utilization control, and discharge planning to support medically necessary, policy-compliant care. Coordinate with hospitals, clinicians, members, and internal teams to ensure timely service delivery and continuity of care.

Adjudicate outpatient and inpatient medical claims against policy guidelines, benefit limits, and clinical protocols. Identify billing discrepancies and potential fraud, request missing documentation from providers, and ensure accurate, timely decisions within internal SLAs.

Provide perioperative nursing care, including preoperative preparation, postoperative monitoring, pain and complication surveillance, and medication administration. Deliver wound care, enforce infection control, support patient education, and maintain accurate clinical and legal documentation while escalating emergencies as needed.

Counsel patients on safe and effective medication use, including dosage, timing, route of administration, side effects, and drug-food interactions. Monitor for adverse drug reactions, assess contraindications to inform prescriber/pharmacist decisions, support medication adherence, and integrate nursing assessment into medication reviews.

Bachelor of Science in Nursing at the University of Nairobi from 2018 to 2022.

Grade: A- (Minus)

Completed the Kenyan Certificate of Secondary Education (KCSE) at Kenyan Friends Bwake Boys School from 2014 to 2017.

Grade: B+

Completed the Kenyan Certificate of Primary Education (KCPE) at Saiwa Primary School from 2004 to 2013.