Specialist, Case Management ( doctor)

Role Purpose

Conduct comprehensive assessments of clients medical, psychological, and social needs.

Develop individualized care plans in collaboration with clients, families, and healthcare providers.

Facilitate access to necessary services, including medical care, therapy, rehabilitation, and social services.

Coordinate with multidisciplinary teams to ensure cohesive care delivery.

Regularly review client progress and adjust care plans as needed.

Conduct follow-up assessments to ensure ongoing support and intervention.

Maintain accurate and up-to-date records of client interactions, assessments, and care plans.

Regularly review and update policies to reflect best practices and regulatory changes.

Implement case management programs that address the needs of high-risk members.

Work closely with other departments, such as authorisation, claims, and customer service, to ensure a seamless experience for members.

Update comprehensive policies and processes for case management to ensure consistency and compliance across the organization.

Utilize data analytics to identify trends, assess program outcomes, and inform decision-making.

Monitor and report on key performance indicators related to case management effectiveness.

Ensure all case management activities comply with relevant laws, regulations, and accreditation standards.

Key Requirements and Qualifications

Minimum 5 years of clinical experience in the healthcare industry

Minimum 3 years of health insurance industry related background

Bachelor's degree in medicine (Master's degree preferred).

Skills and Competencies

Dynamic, self-driven with strong business understanding and background to manage and improve the case management processes

Strong understanding of health insurance operations and case management principles

Strategic thinking with strong focus on results and high quality of work

Very good leadership skills including people management, selection and development skills

Very good command of written/spoken English; knowledge of Arabic language is an added advantage

Very good analytical, planning, forecasting, execution and problem-solving skills

Very good communication, negotiation, and presentation skills

Broad knowledge of project management techniques and tools

Knowledge of regulatory requirements and healthcare compliance