Case Manager

2 weeks ago

Riyadh, Ar Riyāḑ, Saudi Arabia Intelligent Solutions HR Consultancy Full time

General Overview:


Our client, a large Multinational Insurance company is looking to hire a Nurse Case Manager to join their team in Riyadh, KSA.


Responsibilities

  • Manages/coordinates an active volume of cases by providing clinical support, information, navigation, and coordination to customers in KSA.
  • Works with a multicultural population and is constantly aware of the cultural differences among that population.
  • Establishes patient centric goals and interventions to meet the member's needs.
  • Interfaces with the member, family members/caregivers, and the healthcare team, as well as internal matrix partners.
  • Balances business needs with patient advocacy.
  • Assesses member's health status and treatment plan and identifies any gaps or barriers to healthcare.
  • Visits providers to manage and coordinate care for customers by reviewing medical and claim information, ensure compliance with approved services, and discuss cases with hospital staff and physicians.
  • Establishes a documented patient centric case management plan involving all appropriate parties (client, physician, providers, employers, etc), identifies anticipated case results/outcomes, criteria for case closure, and promotes communication within all parties involved.
  • Works with Company physicians to evaluate complex cases and receive appropriate clinical expertise on diagnosis and treatment plans.
  • Responsible for delivering to customers clinical programs including case management, chronic condition management, lifestyle coaching, pre assignment assessment and any other program delivered by global clinical operations.
  • Coordinates care with other nurses from other regions around the world when a need for local or regional expertise is important for better care or to comply with regulations.
  • Maintains accurate workflow and process documents.
  • Adheres to professional practice within scope of licensure and certification quality assurance standards and all case management policy and procedures.
  • Participates in unit and corporate training initiatives and demonstrates evidence of continuing education to maintain clinical expertise and certification as appropriate.
  • Demonstrates sensitivity to culturally diverse situations, clients, and customers.
  • Serves as clinical liaison to Clients.
  • Attends to other clinical duties as assigned.

Benefits:

  • Bachelors in nursing, 35 years of experience in international clinical management
  • Experience as a case manager in Saudi Arabia.
  • Demonstrated organizational and leadership skills.
  • Strong interpersonal and communication skills.
  • Demonstrates problemsolving and analytical skills.
  • Ability to act as an "advocate" for the customer while complying with internal policies and procedures and contractual/legal compliance requirements.
  • Ability to operate personal computer, proficient with Microsoft office products, call centre software, and a variety of software.
  • Experience with clinical guidelines solutions such as coverage policy and MCG guidelines.
  • Ability to build solid working relationships with staff, matrix partners, customers and providers
Work Experience

5+ years

Industry

Insurance

City

Riyadh

Province

Riyadh

Country

Saudi Arabia

Postal Code

11564

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