Description

Job Description

Roles and Responsibilities

Basic Purpose of the role:

The Case Management Manager is responsible for leading and overseeing care management services to ensure the coordination of healthcare access and continuity of care for beneficiaries, particularly high-risk patients and those requiring complex or extended treatment.

The role ensures the effective implementation and monitoring of evidence-based clinical practice guidelines, supports timely and appropriate care delivery, and oversees the management of approvals for additional services and treatment extensions for inpatients in alignment with regulatory and payer requirements.

This position requires a qualified healthcare professional with a minimum of five years of clinical experience, capable of ensuring compliance with applicable Council of Health Insurance standards and organizational policies while enhancing patient outcomes and overall beneficiary experience.

Key responsibilities of the role

Managerial/Administration:

• Lead the implementation and improvement of case management protocols within the Rehabilitation and Long-Term Care department.
• Develop and implement policies and procedures related to case management and care coordination in alignment with hospital standards and regulatory requirements.
• Collaborate with the finance department to manage cost control, insurance pre-authorizations, and reimbursement processes.
• Ensure accurate documentation of patientcare plans, discharge summaries, and case management records.
• Participate in budget planning and resource allocation specific to rehabilitation and long-term care services.
• Oversee the development of individualized care plans that align with medical, psychological, and social needs of long-term and rehabilitative patients.
• Act as a liaison between patients, families, physicians, nursing, allied health professionals, and external care agencies.
• Supervise a multidisciplinary team of case coordinators, social workers, and administrative support personnel.

Technical:

• Lead and oversee the assessment and evaluation of patients clinical, functional, and psychosocial needs upon admission, throughout hospitalization, and at discharge to ensure the development and implementation of individualized, multidisciplinary care plans in collaboration with physicians, nurses, therapists, and social workers.
• Ensure effective coordination of healthcare services for ensured beneficiaries in compliance with applicable regulatory and payer requirements.
• Oversee the coordination of access to care and continuity of care for high-risk patients and individuals requiring complex or extended treatment plans.
• Ensure the implementation and monitoring of evidence-based clinical practice guidelines to promote quality, safety, and standardized care delivery.
• Supervise and coordinate the approval process for additional inpatient services, treatment extensions, and medical necessity reviews in alignment with insurance policies and regulatory standards.
• Monitor and manage length of stay, utilization patterns, and resource allocation to optimize bed capacity, operational efficiency, and cost-effectiveness while maintaining quality of care.
• Coordinate closely with insurance providers, Revenue Cycle Management, and billing departments to facilitate timely authorizations, approvals, and reimbursement processes.
• Participate in and contribute to clinical audits, utilization reviews, risk management activities, and continuous quality improvement initiatives related to rehabilitation and long-term care services.
• Ensure accurate documentation, compliance tracking, and reporting of case management activities in accordance with Council of Health Insurance standards and organizational policies.
• Perform additional tasks and duties as assigned, within the scope of the individual’s knowledge, skills, and abilities.

Quality & Safety:

• Ensure adherence to hospital policies, Saudi health regulations, and international best practices for quality and safety in rehabilitation and long-term care.
• Participate in the development, implementation, and evaluation of quality improvement initiatives and safety protocols.
• Monitor and report on patient safety incidents, adverse events, and outcomes related to rehabilitation and long-term care services.
• Conduct regular audits and compliance checks related to case management and care standards.

Education:

• Advocate for patient rights and ensure culturally sensitive care aligned with Saudi Arabian norms and patient preferences.
• Educate patients and families on care plans, safety practices, and rehabilitation goals to empower informed decision-making.

Compliance guidelines

Complying with Policies, Procedures and Practices of Facilities and other Regulatory Requirements:

• Ensure all case management activities align with the hospital’s internal policies, Saudi Ministry of Health regulations, and other relevant healthcare regulatory frameworks (e.g., CBAHI standards).
• Serve as an advocate for patients’ rights and needs while balancing compliance requirements. Facilitate communication between patients, families, healthcare providers, and insurance companies.
• Keep updated on local healthcare laws, accreditation requirements, and best practices. Implement necessary changes in processes to meet evolving regulations and standards.

Maintaining Confidentiality:

• Maintain strict confidentiality of all patient information, adhering to hospital policies, Saudi health data protection laws, and ethical standards. Handle sensitive patient records and communication with utmost discretion.
• Ensure accurate, timely, and secure documentation of case management activities, interventions, and patient outcomes in compliance with legal and institutional requirements.

Promoting Customer Service Standards:

• Act as the primary liaison between patients, families, healthcare providers, and hospital departments to address concerns promptly and empathetically, promoting a patient-centered experience.

Adhering to the Occupational Health and Safety, Materials Management and Maintenance Standards:

• Identify potential safety risks in rehabilitation and long-term care settings and implement appropriate preventative measures.
• Collaborate with the Maintenance Department to ensure all rehabilitation and long-term care equipment and facilities are well- maintained and functional.

Ensuring Personal Effectiveness:

• Demonstrate strong organizational skills by prioritizing caseloads and managing competing demands effectively
• Engage in continuous professional development to stay current with

rehabilitation and long-term care best practices and regulations in Saudi Arabia.

Qualifications, Certifications and Experience

Qualifications:

• Bachelor’s degree in public health, healthcare provider, Allied healthcare providers or health informatics.

Specialist Certifications:

• Valid professional license issued by Saudi Commission for Health Specialties (SCFHS).
• Certified Rehabilitation Counselor (CRC).
• Certified Long Term Care Administrator (CLTCA).
• Valid Basic Life Support (BLS) certification.

Experience Required in addition to the Qualifications mentioned above (Relevant to the Job):

• Minimum of 6 years of experience, including (at least 5 years of healthcare clinical experience and at least 1 year of experience as a case manager or in public health).

Additional Requirements / Remarks:

• Strong knowledge of rehabilitation and long-term care principles.
• Excellent communication, negotiation, and interpersonal skills.
• Proficient in medical documentation and electronichealth records.
• Sound decision-making and problem-solving abilities.
• Training in Saudi-specific healthcare regulations and cultural competencies.
• Experience or knowledge of Saudi Vision 2030 initiatives related to healthcare transformation can be a plus.
• Fluency in Arabic and English, due to the multicultural work environment.

Physical Requirements

Typical physical demands include: a high degree of manual dexterity to sufficiently perform computer functions on a keyboard, produce materials on a PC and operate basic office equipment, normal or corrected vision and hearing, extensive sitting and walking, mobility.