Case Manager

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.ResponsibilitiesCase Management & Care CoordinationAssess patient medical and clinical needsCoordinate with physicians and nursing teams for treatment planningMonitor patient progress and length of stayIdentify high-risk and long-stay patientsFacilitate patient transfers in collaboration with clinical teams, ensuring medical records, treatment plans, and discharge documentation are complete.Insurance & Revenue Cycle CoordinationCoordinate with insurance companies and TPAs for approvals through the RCM Approval unitEnsure timely pre-authorizations and concurrent approvalsMonitor insurance coverage and eligibilitySupport denial prevention and claim accuracyWork closely with billing and coding teamsEnsure proper clinical documentation for claims submissionFacilitate 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 ApprovalsMaintaining real time tracking of all Inpatient pending approvals and escalating cases exceeding defined turnaround times to relevant stakeholders (Clinical team, RCM insurance).Utilization ManagementMonitor Average Length of Stay (ALOS)Ensure efficient use of hospital resourcesConduct concurrent and retrospective case reviewsSupport cost-effective treatment planningEnsure compliance with payer guidelinesDischarge PlanningCoordinate safe and timely dischargeEnsure discharge documentation is completeCoordinate follow-up care and insurance approvalsDocumentation & 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 reportsRevenue & Quality SupportReduce insurance rejection rateImprove approval turnaround timeSupport revenue optimizationMonitor case management KPIsParticipate in revenue cycle and clinical meetingsInsurance Inpatient approval turnaround timeReduce rejection rateAverage Length of Stay (ALOS)Claim documentation accuracyDischarge efficiencyRevenue cycle support performanceUtilization review compliancePatient throughputQualificationsEducationMBBS / MD / BSNCertified Professional CoderExperienceMinimum 3 years UAE Hospital experienceExperience in case management, utilization review, discharge planning preferredExperience working with insurance and TPAs is an advantage#J-18808-Ljbffr