Nursing Case Coordinator-SKMC-Case Management

Abu Dhabi Health Services; Abu Dhabi; On-site; AED 140,000 - 210,000; Full time

Job summary

Abu Dhabi Health Services seeks an entrant Case Coordinator to coordinate a multidisciplinary team and ensure quality patient care under the guidance and supervision of the Senior Case Coordinator. The role emphasizes advocacy, transition management, and efficient use of resources within the Abu Dhabi healthcare system.

You will develop care plans, facilitate timely transitions, and maintain meticulous documentation, including insurance-related information, to support medical necessity and

Qualifications

• Bachelor degree in Nursing or equivalent required.
• National licensing exam completion required (NCLEX/Provincial).
• Experience in case management or discharge planning is preferred.

Responsibilities

• Coordinate multidisciplinary team to ensure timely patient care.
• Develop patient care plans and ensure utilization management.
• Facilitate transitions and discharge planning with care teams.
• Document medical and health insurance information accurately.
• Monitor length of stay and resource use with Senior Case Coordinator.
• Provide education and advocacy for patients and families.

Skills

Team coordination

Advocacy

Care planning

Documentation

Insurance coordination

Clinical pathways

Education

Bachelor degree in Nursing

Associate degree in Nursing (Canada/USA)

Diploma in Nursing

Diploma in Nursing and Midwifery (3.5 yrs)

National licensing exam (NCLEX/Provincial)

Job description

Description

The role of the new entrant Case Coordinator is to coordinate the multidisciplinary team and any other appropriate and accredited healthcare provider in the provision of quality patient care under the guidance and supervision of the Senior Case Coordinator

Responsibilities

ManagerialThe role includes advocacy & education facilitation transition & financial management outcomes & psychosocial management in order to promote quality safe and timely transition through the healthcare system. Under supervision and guidance from the Senior Case Coordinator the case coordinator will coordinate appropriate providers and access appropriate services to progress the patients episode of care in a timely manner. Until competency level has been achieved as per competency evaluation the Case Manager will develop patient care plans to include:
Correct Level of care placement- Utilization Management
Care Facilitation along the Continuum of Care monitoring against Clinical Pathway and facilitation of transition plans
Proactive Discharge Planning
Facilitation of accurate medical documentation and health insurance documentation
Facilitation of Resource Utilization- ensuring the available funding meets the clinical needs
Links the physician staff with finance.
TechnicalActively participate in regular communication and feedback with Senior Case Coordinator.
Under guidance apply appropriate Evidence Based Medical Necessary screening criteria in support of admission and continued stay reviews and communicates with payers as necessary.
Under supervision coordinate/ delegate to multidisciplinary team members to ensure patient care progression throughout the continuum to ensure that necessary services are provided at the most appropriate level of care and there is a smooth progression of the patient throughout the healthcare system by:
a)Working collaboratively and maintaining active communication with physicians nursing and other appropriate members of the multidisciplinary team to effect timely appropriate patient management.
b)Proactively identifies and resolves variances to clinical pathway and obstacles to discharge.
c)Seek consultation from appropriate disciplines / departments as required to expedite care and facilitate discharge.
Learns and comprehends working knowledge of patients benefits under Insurance contract to ensure patient care is rendered to the maximum stipulation but does not exceed the providers provision for cost of care and collaborations with team to obtain documentation to support medical necessity.
Monitors the patients progress consulting with Senior Case Coordinators on appropriate intervention as necessary to ensure that the plan of care and services provided are patient focused quality efficient and cost effective.
Seeks consultation with the Senior Case Coordinator to facilitate and coordinate the following in a timely manner:
a)advocacy & education of the patient family and relevant others by appropriate care team members
b)transition management to ensure the patient is transitioned to the appropriate level of care
c)monitoring and intervening as necessary to achieve desired goals and outcomes for both the patient and the hospital
d)early assessment and intervention (once deemed competent) to address psychosocial needs including patient family and community and collaborates with Social Workers as appropriate
communicate closely with Utilization & financial managers regarding insurance and other financial issues to ensure appropriate reimbursement for services (once deemed competent)
Completion of all required documentation in patient medical file.
Obtains and maintains appropriate releases of information
Completes Case Management and quality screening for assigned patients (once deemed competent)
Under supervision of Senior Case Coordinator applies approved utilization acuity criteria to monitor appropriateness of admissions and continued stay and documents findings based on department standards.
Monitors length of stay and resource use on an ongoing basis and discusses trends with Senior Case Manager.
Uses quality screens to identify potential issues discuss with Senior Case Manager appropriate planning and interventions.
Quality & SafetyParticipates in clinical performance improvement activities
Assists in the collection and reporting of indicators including LOS excess days resource utilization and readmission rates.
Gather interpret and use data to identify problems and trends and to demonstrate outcomes and cost-effectiveness
Participates in Quality Assurance programs within the clinical care setting
Assists in development of CQI processes for Case Management
Actively participates in the development and implementation of Case Management projects including Clinical Pathways Quality Improvement tools data analysis and variance reporting
Supports physicians in relation to Clinical Documentation impacting Medical Necessity Case Mix Index and Severity of Illness
EducationPlanning teaching supervising and counseling (as required) regarding physical care measures to promote improvement/recover symptom/complication management expected disease progression social/emotional care and community resources

Keeping abreast of Professional Case Management Practice development and updating requirements.

Facilitating patient education based on identified learning needs of the patient and/or those providing care and documents appropriately

Qualifications

Required:

• Bachelor degree in Nursing OR
• Associate degree in Nursing from Canada or USA with minimum two (2) years course duration AND
• Successful completion of the National exam:
• USA: NCLEX - RN
• Canada: Provincial Licensing Exam OR
• Diploma in Nursing and Midwifery of minimum three and half (3 ) years course duration OR
• Diploma in Nursing of minimum three (3) years course duration

Experience:

• Charge Nurse experience 2 years experience Case Management OR
• Staff Nurse experience 4 years experience Case Management OR
• Being current SEHA Senior Charge Nurse or Charge Nurse or Staff Nurse with no experience in Case Management but Completed SEHA Case Management Training Program in lieu of Experience required (this condition is applicable only for current SEHA employees not new joiners)

Desired:

• Experience in Large Healthcare facility

Specialist Certifications:

Required:

• Case Management Certification Credential from international accreditation body

ie. (ANCC ACMA CMSA AACM...) For external Hiring only

Desired:

• Case Management Certification Credential from international accreditation body
• ie. (ANCC ACMA CMSA AACM..) For existing staff and internal Hiring.

Required Experience

IC