Job detail

Job description

Care Management Associate


This position is for one of our potential client in health benefits and services based in Qatar. Hence all interested candidates who are ready to relocate to Qatar may apply.

Requirements:
All Arab nationals only.
Candidates staying in Qatar OR UAE can apply.

Functional Titles Healthcare Associate, Healthcare Facilitator

Position Summary
-Support comprehensive coordination of medical services including Care Team intake, screening and supporting the implementation of care plans to promote effective utilization of healthcare services.
- Responsible for initial review and triage of Care 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 and refers outlier cases (e.g., Length of Stay) to clinical staff (*)
- Identifies triggers for referral into company¿s Case Management, Disease Management, Mixed Services, and other Specialty Programs (*)
- Utilizes eTUMS and other company systems to build, research and enter member information, as needed(*)
- 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.
- Promotes communication, both internally and externally to enhance effectiveness of medical management services (e.g.,health care providers, and health care team members respectively) (*)
- Performs non-medical research pertinent to the establishment, maintenance and closure of open cases - May assist in the research and resolution of claims payment issues.
- Supports the administration of the hospital care, case management and quality management processes in compliance with various laws and regulations, URAQ and/or NCQA standards, Case Management Society of America (CMSA) standards where applicable, while adhering to company policy and procedures (*)
¿ Exhibits behaviors outlined in Care Management Associate Competencies


Background/Experience Desired
2-4 years experience as a medical assistant, office assistant.
Education and Certification Requirements
High school diploma or G.E.D.


Additional Information (situational competencies, skills, work location requirements, etc.)
¿ Strong customer service skills to coordinate service delivery including attention to customers, sensitivity to issues, proactive identification and resolution of issues to promote positive outcomes for members.
¿ Computer literacy in order to navigate through internal/external computer systems, including Excel and Microsoft Word.
¿ Familiarity with basic medical terminology and concepts used in care management.