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Case Manager
JOB_REQUIREMENTS
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Case management of insured cases.
Ensuring submission of optimal documentation
Monitoring for correct coding and billing practices for inpatient and outpatient cases.
Rejection analysis
Healthcare provider monitoring and ongoing education
Minimizing DRG variances
DUTIES AND RESPONSIBILITIES
Promote quality and cost-effective interventions and outcomes.
Record case information, complete accurately all necessary forms and produce statistical reports.
Develop effective working relations and provide feedback to administrative, medical, and RCM team throughout the entire case management process.
Advise healthcare providers on correct documentation, optimal resource utilization and controlling outlier expenses.
Promote correct completion of documentation to ensure correct E&M coding, correct CMI calculation and DRG severity levels.
Advise departments on the optimal case mix.
Ensure minimal leakages of potential revenue.
Advise doctors on best practice trends.
Evaluate and develop training sections to avoid rejections.
Random file audits with regular feedback to concerned departments.
OSH ROLES AND RESPONSIBLITIES:
GENERAL:
- Responsible for implementation of OSHAD-SF& NMCSH Al Ain Internal OSHMS/ OSHMS /EHSMS policies and procedures/SOP’s relevant to their department.
- Should notify/report all OSHMS/EHSMS hazards, incidents, accidents and near misses within the premises of NMCSH Al Ain to their supervisor or department OSH Facilitator as per the incident reporting protocol of NMCSH Al Ain.
- Should familiarize them and comply with all NMCSH Al Ain OSHMS /EHSMS policies, standards and procedures that are relevant for their workplace.
- Responsible to attend applicable department OSHMS /EHSMS training and follow NMCSH Al Ain policies and procedures.
- Responsible for taking reasonable care for their health and safety of persons and the Occupational that may affect by the labor act or omissions at the workplace.
- Responsible to wear all PPE’s provided to them.
- Staff is not allowed to tamper or misuse any NMCSH Al Ain equipment’s and its property.
- Should abide all safety instructions and signages within the premises of NMCSH-Al Ain.
- Responsible for following and complying with any specified OSH/EHS procedures associated to the task/job.
SPECIFIC:
- Lead the development of appropriate OSH management system.
- The ultimate responsibility for Occupational, Health and Safety within all facilities of NMCSH, Al Ain.
- Shall allocate adequate resources for OSH management ( e.g. Budget , human resources, equipment’s)
- The GM approves and endorses NMCSH, Al Ain EHSMS/OSH Policies and Procedures/Programs /Plan.
- Sets and approves a clear OSH Policy for NMCSH, Al Ain. Ensure that the OSH policy is reviewed annually.
Sound clinical training and background.
Medical/ Allied Graduate.
Sound coding, Billing, auditing approval and clinical known.
International certification in coding.
Preferred auditing certification / Training.
Clinical experience of 5 year in hospital.
At least two years supervisory experience.
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