CARE MANAGEMENT ASSOCIATE

Duties and responsibilities:

  • Responsible for initial review and triage of the care management team tasks.

  • Identifies principle reason for admission, facility, and member product to correctly apply intervention assessment tools.

  • Screens patients using targeted intervention business rules and processes to identify needed medical services, make appropriate referrals to medical services staff and coordinate the required services in accordance with the benefit plan.

  • Identifies cases to be referred to clinical staff or to case management, disease management or other programs.

  • Coordinates and arranges for health care service delivery under the direction of nurse or medical director in the most appropriate setting at the most appropriate expense by identifying opportunities for the patient to utilize participating providers and services.

  • Performs non-medical research pertinent to the establishment, maintenance and closure of open cases.

  • Promotes communication both internally and externally to enhance effectiveness of medical management services (e.g. healthcare providers, etc.)

  • Provides support services to team members by answering telephone calls, taking messages, researching information and assisting in solving problems.

  • Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements.

Competencies:

  • Managerial skills:

Organization skills

Excellent communication skills

Analytical thinking 

  • Technical skills:

Computer knowledge internal/external computer systems excel and word

Familiarity with basic medical terminology and concepts used in care management

Effective telephonic skills 

  • Personal Attributes:

Team oriented

Strong Customer services skills

Requirements

  • High school diploma or General Education Diploma

  • 2 to 4 years of experience as a medical assistant, office assistant

  • Fluent in English and Arabic

CARE MANAGEMENT NURSE SUPERVISOR

Duties and responsibilities:

  • Responsible for the management of medical services staff including resources responsible for identification of members, development/ implementation of care plans, enhancement of quality of care, monitoring, evaluation and documentation of care.

  • Works closely with case & disease managers ensuring consistency in care management interventions

  • Oversees the implementation of the organization’s medical management services and monitors daily performance to ensure business goals are met.

  • May acts as a liaison between the care management program design, specialty services and other care management programs to ensure successful implementation of the different care programs.

  • Communicates productivity expectations, balance workload, efficiency monitoring and initiates control measures to minimize variances in workload over time.

  • Delivers training sessions & acts as a coach to the team in regards to practice standards, quality of intervention as well as problem solving & critical thinking.

  • Collaborates with others to identify and implement action plans that support the development of high performance teams.

  • Handles managerial tasks such as: selection of staff based on defined requirements, establishment of a positive work environment & team spirit, articulation of team objectives and evaluation of team performance.

Competencies:

  • Managerial skills:

Excellent communication skills

Leadership skills

Multitasking abilities

Analytical thinking 

  • Technical skills:

Computer knowledge, excel, MS Word, and web-based applications

Advanced knowledge of the medical terminology and concepts used in care management 

  • Personal Attributes:

Team work spirit

Assessment techniques

Requirements

  • Registered Nurse – Bachelor of Nursing is preferred

  • Certification in case management from URAC is a plus

  • 3 to 5 years of clinical experience 

  • Fluent in English and Arabic

CASE MANAGER

Duties and responsibilities:

  • Responsible to conduct comprehensive assessments of member’s needs by using clinical tools and data review, and determine approach to case resolution and/or meet needs by evaluating member’s benefit plan and available internal and external programs/services.

  • Applies and /or interprets applicable criteria and guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and member’s needs to ensure appropriate administration of benefits.

  • Consults with supervisors, medical directors and other parties to overcome barriers to meeting goals and objectives; presents cases for review in order to achieve optimal outcomes.

  • Identifies and escalates quality of care issues through established channels.

  • Implements case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

  • Uses assessment techniques to determine member’s level of health literacy, technology capabilities, and/or readiness to change.

  • Applies negotiation skills to secure appropriate services necessary to meet the member’s benefits &/or healthcare needs.

  • Uses influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.

  • Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.

Competencies:

  • Managerial skills:

Excellent communication skills

Negotiation skills

Leadership skills

Multitasking abilities & Analytical thinking 

  • Technical skills:

Computer knowledge including navigating multiple systems and keyboarding 

  • Personal Attributes:

Team oriented

Assessment techniques

Requirements

  • Registered Nurse 

  • Case Management Certification “CCM” is preferred 

  • 3 to 5 years of clinical practice experience 

  • Healthcare and/or managed care industry experience 

  • Case management experienced is preferred 

  • Fluent in English and Arabic

CARE MANAGEMENT NURSE MANAGER

Duties and responsibilities:

  • Oversees the medical services staff (clinical & non-clinical) as well as the implementation of the organization’s medical management services policies.

  • Manages resources responsible for identification of members, development/ implementation of care plans, enhancement of quality of care, monitoring, evaluation and documentation of care.

  • Acts as a liaison between the care management program design, specialty services and other care management programs to ensure successful implementation of the different care programs.

  • Evaluates clinical, financial, and medical management data and assigns resources accordingly to ensure cost effective quality outcomes.

  • Promotes cost effective outcomes and improve program/operational efficiency involving clinical issues.

  • Evaluates operational performance data (phone reports, nursing audits…) and implements procedural or training solutions to close gaps.

  • Provides direction and assistance in the review, selection, development and implementation of vendor- contracted activities related to medical management programs.

  • Provides feedback to other departments on benefit design and clinical policies when they relate to implementation of the medical services model.

  • Acts as a mentor to the care management supervisors, providing leadership opportunities.

  • Identifies, communicates and implements strategic plans of the unit and ensures proper implementation of tactics to meet plans.

  • Handles managerial tasks of the Care Management Unit including the preparation of the budget and budget status, the articulation of unit objectives, the staff performance and compensation reviews as well as the staff development programs and a continuous positive work environment and team spirit. 

Competencies:

  • Managerial skills:

Excellent communication & presentation skills

Decision-making skills

Leadership skills 

  • Technical skills:

Computer knowledge, excel, MS Word, and web-based applications 

  • Personal Attributes:

Team oriented

Customer service orientation

Assessment techniques

Requirements

  • Registered Nurses, Bachelor is a plus 

  • 5 to 7 years of clinical experience 

  • Fluent in English and Arabic

 
 

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