Description

Job 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 & Compliance

Coordinate with the clinical team to ensure proper and complete medical documentation to support insurance approvals, coding, and billing requirements.

Maintain accurate case management records

Ensure compliance with health regulations, Insurance policies, and hospital revenue cycle policies

Support Insurance audits

Prepare utilization and case management reports

7. Revenue & Quality Support

Reduce insurance rejection rate

Improve approval turnaround time

Support revenue optimization

Monitor case management KPIs

Insurance Inpatient approval turnaround time

Reduce Rejection Rate

Average Length of Stay (ALOS)

Claim documentation accuracy

Discharge efficiency

Revenue cycle support performance

Utilization review compliance

Patient throughput

Participate in revenue cycle and clinical meetings

Qualifications
Education

MBBS / MD / BSN

Certified Professional Coder

Experience

Minimum 3 years UAE Hospital experience
Experience in case management, utilization review, discharge planning preferred
Experience working with insurance and TPAs is an advantage