Case Manager

NMC Healthcare View all jobs

  • Sharjah
  • Permanent
  • Full-time
  • 17 days ago
Job Category: AdministrationJob Description:The Case Manager is responsible for coordinating patient care, managing insurance approvals, monitoring resource utilization, and ensuring efficient discharge planning while supporting the Revenue Cycle Department. The role focuses on optimizing insurance approvals, reducing claim denials, ensuring medical necessity documentation, and improving hospital revenue through effective case and utilization management in compliance with UAE healthcare regulations.Responsibilities: * Case Management & Care Coordination
  • Assess patient medical and clinical needs
  • Coordinate with physicians and nursing teams for treatment planning
  • Monitor patient progress and length of stay
  • Identify high-risk and long-stay patients
Facilitate patient transfers in collaboration with clinical teams, ensuring medical records, treatment plans, and discharge documentation are complete.2. Insurance & Revenue Cycle Coordination
  • Coordinate with insurance companies and TPAs for approvals through the RCM Approval unit
  • Ensure timely pre-authorizations and concurrent approvals
  • Monitor insurance coverage and eligibility
  • Support denial prevention and claim accuracy
  • Work closely with billing and coding teams
  • Ensure proper clinical documentation for claims submission
  • Facilitate insurance company and TPA visits for medical file reviews and case audits.
Monitor and ensure timely bill updates by coordinating with clinical, coding, and billing teams to avoid claim delays and ensure accurate revenue capture.
  • Real-Time Visibility & Escalation of Inpatient Pending Approvals
  • Maintaining real time tracking of all Inpatient pending approvals and escalate cases exceeding defined turnaround times to relevant stakeholders (Clinical team, RCM insurance).
4. Utilization Management
  • Monitor Average Length of Stay (ALOS)
  • Ensure efficient use of hospital resources
  • Conduct concurrent and retrospective case reviews
  • Support cost-effective treatment planning
  • Ensure compliance with payer guidelines
5. Discharge Planning
  • Coordinate safe and timely discharge
  • Ensure discharge documentation is complete
  • Coordinate follow-up care and insurance approvals
6. Documentation & ComplianceCoordinate with the clinical team to ensure proper and complete medical documentation to support insurance approvals, coding, and billing requirements.Maintain accurate case management recordsEnsure compliance with health regulations, Insurance policies, and hospital revenue cycle policiesSupport Insurance auditsPrepare utilization and case management reports7. Revenue & Quality SupportReduce insurance rejection rateImprove approval turnaround timeSupport revenue optimizationMonitor case management KPIsInsurance Inpatient approval turnaround timeReduce Rejection RateAverage Length of Stay (ALOS)Claim documentation accuracyDischarge efficiencyRevenue cycle support performanceUtilization review compliancePatient throughputParticipate in revenue cycle and clinical meetingsQualifications:EducationMBBS / MD / BSNCertified Professional CoderExperience
  • Minimum 3 years UAE Hospital experience
  • Experience in case management, utilization review, discharge planning preferred
Experience working with insurance and TPAs is an advantage

NMC Healthcare