George Gutuma

WORK EXPERIENCE

 AUGUST 2019- JUNE 2022 GALAXY HOSPITAL LTD ISIOLO

CARE/CLAIMS MANAGER OP/IP-2021-2022

The specific objective of the above role chiefly involves timely processing of claims, appropriate documentation, review of patient’s health benefits, eligibility and generation of periodic reports and     statements. Other responsibilities are as listed below: -

• Daily verification of NHIF and corporate insurances. This includes making sure all inpatient and outpatient visits are timely notified at the point of registration.
• Confirming the eligibility and ensure both admitted and outpatient clients are receiving services accordance to their medical cover. 
• Record keeping. Maintain fails for claims and make sure are available when need arises.
• Daily processing of claims and preauthorization thus reducing backlog and timely submission.
• Overseeing claims are processed at departmental level i.e Dental, Optical and Radiology.
• Check and advice other team members on benefits that the patients are eligible to, premiums that the patient is subscribed to.
• File all the correspondences and share all updates with other departments.
• Work with internal and external auditors, help prepare audit reports and scheduled requirements.
• Help in policy formulation enhance easy and better management of schemes and ease claim process.
• Prepare daily and monthly reports.
• Follow up on preauthorized services to ensure are approved within acceptable timeline and patient receive the service without delay.
• Have a broad depth of knowledge and expertise in situational analysis.
• Proper documentation. Ascertain all the relevant documents are attached together with their case note (medical reports).
• Implementing fraud mitigation strategy that prevent incidences of fraud that might happen and affect our daily operations.
• Liaising with insurers on scope of cover for various schemes.
• Gathering/obtaining and share relevant information on claims with multidisciplinary team under my job jurisdiction.
• Having a friendly and non-judgmental interaction with clients, insurers and clinical team as needed to resolve problems in a manner that is legal, ethical and consistent with the principles of the policy.
• Review medical preauthorization for compliance within applicable policy guidelines before submission and also giving guidance to other care management team (clinical team).
• Advocate for proper care and treatment of patient within acceptable protocols.

REGISTERED NURSE-2019-2021

• Assisted physicians in taking blood pressure, measuring heartbeat, and recording vitals in physical examinations
• Collaborated with 4 other nursing staff in maintaining a calm environment  caring for patients
• Supervised the admission of patients in emergency cases and directed the transferring of patients from their locations to the hospital via ambulance.
• Commended by supervisors for handling difficult situations involving both patients and their families
• Deliver high level of care to patients in both inpatient and outpatient settings.
• Provide a variety of healthcare services, such as conducting comprehensive health assessments, prescribing treatments, making referrals, and managing acute illnesses.
• Maintain a safe environment for patients and staffs by consistently observing infection control procedures.
• Control the traffic or influx of patients coming in unit to avoid the spread of infection.
• Accompany the patients during inpatient or referrals and ensure their safety and comfort as they transferred.
• Ensure the patient’s comfort, communicate in a manner that can be easily understood and provide reassurance and explanations consistently 

AUGUST 2018-JUNE 2019 RUAI FAMILLY HOSPITAL–NAIROBI 

REGISTERED NURSE

• Provide direct quality care to patients including daily monitoring, recording, and evaluating of medical conditions of up to 20 patients per day
• Developed and direct a rotational system in managing the care of patients in the department
• Coordinate workforce management objectives with a focus on individual, departmental, and hospital-wide initiatives
• Interact and communicate with patients of all ages and ethnic       backgrounds giving quality medical care and treatment
• Acted as a focal point of contact for clients and primary care providers to ensure the provision of high- quality care.
• Lead and mentored 2 newly licensed nurses in developing and achieving professional expertise.
• Get and record patients vital signs blood pressure, heart rate, respiratory rate and temperature including oxygen saturation using pulse oximeter.
• Observes, records and report patient’s condition, reaction to drugs treatment and significant incidents.
• Perform standard care to all patient. This includes daily bed bath, oral care, perineal care, endotracheal tube care and airway management. 
• Assesses patients level of consciousness using Glasgow coma scale.
• Administer medication through intramuscular, subcutaneous and intravenous route.
• Regulate intravenous fluids and iv medication and inotropic drugs accurately using infusion pump.
• Monitor, refer and document any adverse reaction experienced by the patient.
• Administer blood products such as packed red blood cells and whole blood, fresh frozen plasma, platelet concentrate via moderate fast drip.
• Observe for allergic reaction during blood transfusion such as respiratory distress, chills, fever and flushing.
• Suction secretions of patient who are unable to expectorate sputum as well as those who are intubated through oral endotracheal route.

PROFESSIONAL QUALIFICATION

2015- 2018: KENYA MEDICALTRAINING COLLAGE-NYAMIRA CAMPUS 

• Diploma in Kenya Registered Community Health Nursing-obtained practicing license under Nursing Council of Kenya.

Area of specialization

• Midwifery
• General Nursing
• Leadership and Management
• Research
• Medical ethics
• Psychology and Counselling.
• Psychiatry
• Community health
• Trauma and Emergency response.

NYAMACHE SECONDARY SCHOOL2009-2013

• Kenya Certificate of Secondary Education [KCSE]

GSUPRIMARY SCHOOL 2000 –2008

• Kenya Certificate of Primary Education [KCPE]

OTHERS COURSES AND TRAINING

• Diploma in Mental Health-2022
• Diploma in Nursing Leadership and Care Management-2021
• Asthma management for primary healthcare professionals-2021
• KDSG Diabetes online nurses short course-2021