Medical Case Manager
6 months ago
Coordinates the care and services delivered to contracted patients accepted for treatment at KFSH&RC, to ensure effective utilization and monitoring of health care resources, provides a leadership role within the interdisciplinary team to achieve desired clinical, financial and resource outcomes within defined time frames.
**Essential Responsibilities and Duties**:
1.Maintains up-to-date knowledge of current practice, accreditation and industry standards of utilization review and case management, in order to assess the continuum of care and patient care processes of contracted patients.
2.Compares inpatient medical records to establish criteria and confers with Health Care professional to determine appropriate length of stay.
3.Uses ARAMCO program called SAHL to view data and act accordingly as well as enters ARAMCO patient’s data.
4.Assesses, develops, implements and monitors a comprehensive plan of care through an interdisciplinary team approach in conjunction with the patient and the family within the hospital setting.
5.Collaborates with the health care team, assesses the appropriateness of the level of care, diagnostic testing and clinical procedures, quality and clinical risk issues and documentation of medical record completeness.
6.Reports variances through established quality improvement processes.
7.Communicates continually with patients, families, medical staff, caregivers and thirty party guarantors as necessary.
8.Facilitates or provides necessary patient and family education, prior to admission, during hospitalization and after discharge as indicated.
9.Analyses outcome data that includes, but is not limited to readmission, unplanned discharge and patient satisfaction and makes recommendation for change within a designated service line.
10.Orients health care staff to the Business Centre Clinical Representative duties.
11.Initiates/participates in strategies to promote continuity of care across the care continuum such as Clinical Pathways or Care Map Systems.
12.Matches patient needs to available resources and works as patient’s advocate.
13.Follows all Hospital-related policies and procedures.
14.Participates in self and other’s education, training and development, as applicable.
15.Performs other related duties as assigned.
**Education**:
Bachelor’s or Associate Degree/Diploma in Nursing is required.
**Experience Required**:
Four (4) years of acute hospital nursing experience within specialized service area with Bachelor’s Degree or six (6) years of similar requirements with Associate Degree/Diploma is required.
**Other Requirements(Certificates)**:
Graduate from an Accredited School of Nursing, Current Registered Licensure from country of origin required.
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