Case Manager

3 months ago

Riyadh, 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, 3-5 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 problem-solving 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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