Nurse - Case Manager - Insurance TPA

Company : Confidential Company Dubai

Job Type : Full Time

Dubai, Dubai

Number of Applicants

:

000+

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Job Description - Nurse - Case Manager - Insurance TPA

Uses clinical knowledge to assessdiagnosis and treatment plans and goals and identifies gaps in careor risks for readmission orcomplications.
Manages/coordinates an activevolume of cases by providing information, navigation andcoordination to customers worldwide.
Works witha multicultural population and is constantly aware of the culturaldifferences among that population.
Establishespatient centric goals and interventions to meet themember’s needs.
Interfaces with themember, family members/caregivers, and the healthcare team, as wellas internal matrix partners.
Balances businessneeds with patient advocacy.
Assessesmember’s health status and treatment plan and identifiesany gaps or barriers to healthcare.
Visitproviders to manage and coordinate care for customers by reviewingmedical and claim information, ensure compliance with approvedservices and fees and discuss cases with hospital staff andphysicians.
Establishes a documented patientcentric case management plan involving all appropriate parties(client, physician, providers, employers, etc), identifiesanticipated case results/outcomes, criteria for case closure, andpromotes communication within all partiesinvolved.
Work with physicians to evaluatecomplex cases and receive appropriate clinical expertise ondiagnosis and treatment plans.
Responsible fordelivering to customers clinical programs including casemanagement, chronic condition management, lifestyle coaching, preassignment assessment and any other program delivered by globalclinical operations.
Coordinate care with othernurses from other regions around the world when a need for local orregional expertise is important for better care or to comply withregulations.
Maintains accurate workflow andprocess documents.
Adheres to professionalpractice within scope of licensure and certification qualityassurance standards and all case management policy andprocedures.
Participates in unit and corporatetraining initiatives and demonstrates evidence of continuingeducation to maintain clinical expertise and certification asappropriate.
Demonstrates sensitivity toculturally diverse situations, clients andcustomers.
Serve as clinical liaison toClients.
Other duties asassigned.

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