Job detail

Job description

Case Management Coordinator

This vacancy is with one of our potential clients(a US based cmpany) which is a healthcare benefits and insurance company.
The job location is Qatar.

Background/Experience Desired

¿ Managed Care experience preferred
¿ Case management and discharge planning experience preferred
¿ 2 years experience in behavioral health, social services or appropriate related field equivalent to program focus



Education and Certification Requirements

Bachelors degree or non-licensed master level clinician required, with either degree being in behavioral health or human services preferred (psychology, social work, marriage and family therapy, counseling).


Case Management coordinator:

Utilizes critical thinking and judgment to collaborate and inform the case management process, in order to facilitate appropriate healthcare outcomes for members by providing care coordination, support and education for members through the use of care management tools and resources.

Fundamental Components & Physical Requirements include but are not limited to:
¿ Evaluation of Members:
-Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred member¿s needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating member¿s benefit plan and available internal and external programs/services. Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate. Coordinates and implements assigned care plan activities and monitors care plan
progress.

¿ Enhancement of Medical Appropriateness and Quality of Care:
- Using holistic approach consults with case managers, supervisors, Medical Directors and/or other health programs to
overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes.

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

-Utilizes negotiation skills to secure appropriate options and services necessary to meet the member¿s benefits and/or healthcare needs.

- Utilizes 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.

-Helps member actively and knowledgably participate with their provider in healthcare decision-making.



Monitoring, Evaluation and Documentation of Care:

- Utilizes case management and quality management processes in compliance with regulatory and accreditation
guidelines and company policies and procedures.

¿ Exhibits behaviors outlined in Case Management Coordinator Competencies