Clinical Case Specialist
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Key skills for this role
About the Role
We are hiring an experienced professional to support healthcare operations by coordinating patient care, facilitating medical service approvals, and ensuring compliance with clinical and regulatory standards.
Key Skills for This Role
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Overview
- We are hiring an experienced **professional** to support healthcare operations by coordinating patient care, facilitating medical service approvals, and ensuring compliance with clinical and regulatory standards.
- The role focuses on improving patient outcomes through effective case coordination, clinical assessment, and collaboration with healthcare providers and insurance teams.
- ***Key Responsibilities:***
- Review and assess medical cases for approvals and care coordination
- Develop and monitor individualized patient care plans
- Conduct concurrent medical record reviews and ensure compliance with clinical guidelines
- Coordinate with healthcare providers, insurers, and internal stakeholders for seamless patient support
- Support complex medical cases, escalations, and utilization management activities
- Monitor case management KPIs and recommend process improvements
- Ensure compliance with healthcare regulations and quality standards
- Prepare reports, analyze service gaps, and support operational excellence initiatives
- ***Requirements:***
- Bachelor’s Degree in Nursing, Healthcare Management, Medicine, or related field
- Master’s Degree or professional certifications such as CCM/CPHM will be an advantage
- 2–4 years of experience in case management, healthcare operations, or medical insurance
- Strong knowledge of clinical assessment, medical authorization, and healthcare regulations
- Excellent communication, coordination, and stakeholder management skills
- Pay: AED5,000.00 - AED10,000.00 per month
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