Case Management Specialist

Nextcare; Dubai; On-site; AED 223,200 - 334,800; Full time

Job summary

Nextcare is seeking a Case Management Utilization Review Specialist in Dubai to manage high-cost cases, ensuring compliance with departmental goals. Responsibilities include liaising with teams to develop protocols, evaluating case management performance, and achieving monthly savings targets. The ideal candidate holds a Bachelor’s of Medicine (MBBS) and has over 5 years of medical experience, ideally within insurance. Proficiency in MS Office is essential, and candidates must be legally permitted to work in the UAE.

Qualifications

• 5+ years of medical practical experience, preferably with an insurance provider.
• Legally permitted to work in the UAE.
• Physically fit to carry out duties.

Responsibilities

• Liaise with the Case Management team to develop case management protocols.
• Manage high risk and long stay cases to ensure compliance.
• Achieve monthly savings target of AED 1M.

Skills

Medical practical experience

Fluency in MS Office

Knowledge of insurance industry practices

Education

Bachelor’s of Medicine (MBBS)

Job description

Case Management Utilization Review Specialist manages high-cost cases ensuring departmental goals are met, timelines are adhered to, and all compliance measures are taken care of. This report directly reports to Assistant Manager – Case Management Utilization Review.

Responsibilities

• Liaise with the Case Management team to develop and implement case management protocols, as well as provide training for the team.
• Identifying and reporting clinical cost drivers to plan Field Control Officers or File Reviews.
• Managing high risk and long stay cases.
• Evaluating Provider & Clinician Abuse to red flag the team and create a framework for cost controls.
• Coordinating with BD Team & Payers to manage the expectations from Case Management perspective.
• Auditing & signing off the monthly case management savings report and sharing with the Assistant Manager.
• Manage jumbo discounts above 250k AED claim value.
• Coordinate with providers & vendors to get the best cost effective outcome for elective cases.
• Ensuring timely closure of disputed cases & cases pending with insurance payers.
• Achieve a monthly savings target of AED 1M in line with the criteria or methodology defined by the line manager and head of department.
• Work closely with the audit and fraud waste team to flag providers and clinicians with activities of misrepresentation or malpractice.
• Ensure timely reviews & decision making of high cost cases above AED 75,000.
• Assessing cases with multiple admissions and readmission to gauge the provider practice as well as investigate the medical negligence if any.
• AI readiness: work effectively in an environment shaped by artificial intelligence (AI), machine learning, data, analytics and cloud-based tools, using insights responsibly with our standards of data governance, security and ethical use.

Qualifications

• Bachelor’s of Medicine (MBBS).
• 5+ years medical practical experience (reputable insurance provider, broker, or a TPA experience a plus).
• Knowledge of overall insurance industry practices is a plus.
• Legally permitted to work in the country of operations.
• Physically fit to carry out duties.
• Fluency in MS Office (Excel, Word, Outlook, PowerPoint) and general internet navigation and research skills.

Hiring Process

Agency Statement: Allianz Partners does not accept unsolicited CV’s or approaches from agencies. We only work with partners on our approved supplier list, under contract. Any unsolicited submission will not be considered.

Equal Opportunity Employer

We therefore welcome applications regardless of ethnicity or cultural background, age, gender, nationality, religion, social class, disability or sexual orientation, or any other characteristics protected under applicable local laws and regulations.