Case Coordinator in SSMC Abu Dhabi

• Maintains active communication with physicians, nurses, and other appropriate members of the multidisciplinary team for the appropriate patient care management.
• Participates in regular communication and feedback with the Senior Case Coordinator.
• Manages evidence-based Medical Necessary screening criteria in support of admission and continued stay reviews and communicates with payers as necessary
• Determines Correct Level of care placement- utilization management
• Provides accurate medical documentation and health insurance documentation
• Facilitates resource utilization- ensuring the available funding meets the clinical needs
• Acts as a liaison between clinician and revenue department
• Identifies and resolves variances to clinical pathways and obstacles to discharge.
• Consults from appropriate disciplines/departments as required expediting care and facilitating discharge.
• Ensures patient care is rendered to the maximum stipulation based on the patient’s benefits under the Insurance contract without exceeding the providers’ provision for the cost of care
• Monitors and intervenes as necessary to achieve desired goals and outcomes for both the patient and the hospital
• Assesses and intervenes to address psychosocial needs including patient, family, and community, and collaborates with social workers as appropriate
• Supports physicians in relation to Clinical Documentation impacting Medical Necessity, Case Mix Index, and Severity of Illness
• Monitors length of stay and resource use on an ongoing basis and discusses trends with the Senior Case Manager
• Assists in the collection and reporting of indicators including LOS, excess days, resource utilization, and readmission rates.
• Acts as a patient advocate in facilitating education based on identified learning needs of the patient and/or those providing care and documents appropriately

QUALIFICATIONS

• Bachelor’s Degree in Nursing
• Degree in Nursing (minimum two (2) years course duration) and Registration as a Registered Nurse from Canada, USA, UK, Ireland, South Africa, New Zealand, and Australia
• Valid/Current national license.
• BLS
• 6 years of experience of which not less than 2 years in Case Management in a similar healthcare facility

Quality Coordinator in American Hospital Dubai