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 minimise the financial risk for the organisation

KEY RESPONSIBILITY AREAS:

1. Effective coordination of patient care plans to minimise financial risk for the company

2. Effectively manage the quality of clinical documentation

3. Provide clinical expertise for managing insurance claims with the supportive medical justifications based on good clinical practice

4. Focus on continuous quality improvement of clinical documentation

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 recognised 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