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Tilus Chege

@tiluschege

Medical Case Manager at Medical Administrators of Kenya Limited who reviewed clinical documents and supported claims and pre-authorisation.

Kenya

Message

What I'm looking for

I’m interested in opportunities in medical case management, claims assessment, health insurance administration, clinical operations, and healthcare quality.

At Medical Administrators of Kenya Limited, I followed up on medical cases and reviewed supporting documents for public-sector, corporate, and institutional medical schemes, including those for the National Police Service and the Teachers Service Commission.

I supported pre-authorisation and claims assessment by checking clinical information and documentation, following up on outstanding records, and referring cases for further review when needed.

At Bliss/Nairobi West Hospital and Naivasha District Hospital, I assessed patients, developed initial diagnoses and treatment plans, and monitored progress for medical and surgical conditions.

My clinical background helps me understand medical reports and treatment requirements. I’m interested in medical case management, claims assessment, health insurance administration, clinical operations, and healthcare quality.

Experience

Work history, roles, and key accomplishments

Medical Case Manager

Medical Administrators of Kenya Limited

Jan 2021 - Dec 2024 (3 years 11 months)

Followed up on medical cases, reviewed medical reports and claims documents, and supported pre-authorisation and claims assessment processes. Communicated with healthcare providers to resolve case-related issues and maintained confidential case records.

Medical Case Management Claims Assessment Prior Authorizations Healthcare Benefits Administration Patient Provider Communication Patient Care Coordination Medical Records Microsoft Word Excel Hospital Management Systems Electronic Medical Records

Medical Officer

Bliss/Nairobi West Hospital

Jan 2017 - Dec 2020 (3 years 11 months)

Provided clinical care to patients with medical and surgical conditions, including patient assessment, diagnosis, treatment planning, and monitoring. Maintained accurate medical records and coordinated patient management with healthcare professionals.

patient assessment Clinical Assessment Diagnosis Treatment Planning Laboratory Tests Patient Monitoring Medical Records Patient Education Care Coordination Confidentiality

Medical Officer

Naivasha District Hospital

Jan 2016 - Dec 2017 (1 year 11 months)

Provided clinical services to patients with a range of medical and surgical conditions, including patient assessment, diagnosis, treatment, and documentation. Coordinated with other healthcare professionals to support patient care.