Case Manager

MAIN PURPOSE OF JOB

Effectively and efficiently manage the hospital case management process and facilitate the communication process between all role players by providing accurate and timeous clinical information to minimize the financial risk for the organization

KEY RESPONSIBILITY AREAS

• Effective coordination of patient care plans to minimize financial risk for the company
• Effectively manage the quality of clinical documentation
• Provide clinical expertise for managing insurance claims with the supportive medical justifications based on good clinical practice
• Focus on continuous quality improvement of clinical documentation
• Conduct concurrent and retrospective utilization reviews to ensure medical necessity, appropriate level of care, and compliance with payer requirements.
• Monitor Length of Stay (LOS) and facilitate timely discharge planning
• Coordinate with treating physicians and insurance teams to obtain timely approvals, extensions, and medical necessity documentation
• Collaborate with physicians, coding, nursing, finance, and insurance teams to ensure accurate clinical documentation, timely payer communication, and optimal reimbursement while maintaining compliance with regulatory and payer requirements.

REQUIRED EDUCATION

• Essential: Bachelor Degree or Diploma in Nursing or Medicine Non-licensed Physician
• Desired: Bachelors or Master’s Degree in Healthcare Management from a recognized institution Certificate in Clinical Coding (CCS/CCA/CPC/CPMA)

REQUIRED EXPERIENCE

• Essential: At least 3 years’ experience in a clinical, insurance, medical auditing or coding role in a DRG billing environment within the UAE of which at least 1 year was in UAE Healthcare
• Desired: Experience in Theatre and/or ICU, Medical Insurance/funders background; experience in private healthcare environment or experience as a paramedic

REQUIRED JOB SKILLS AND KNOWLEDGE

• Application of clinical codes
• Computer literacy and proficiency in MS Office applications
• Electronic Health Records systems and related best practice
• Healthcare revenue cycle management and billing processes
• ICD-10 CM, CPT and DRG coding system
• Knowledge of scientific nursing processes and associated procedures
• Patient administration systems and related processes
• Understanding of and working knowledge of the typical patient journey through a hospital and the various service points of contact