Job Description

JOB OVERVIEW:

The Case Manager coordinates comprehensive care for patients with complex medical needs. They assess clinical and social factors, develop individualized care plans, facilitate transitions across care settings, and collaborate with interdisciplinary teams to optimize outcomes, manage resources, and ensure cost-effective, quality-driven care.

JOB SCOPE:

The Case Manager works with patients in inpatient, outpatient, and community settings to assess, plan, implement, and evaluate treatment and support services. They identify needs related to medical stability, functional status, social determinants of health, and post-discharge care. Responsibilities include care coordination, utilization management, discharge planning, and ensuring timely access to services, medications, equipment, and community resources. They collaborate with physicians, nurses, social workers, therapists, pharmacists, and payers to authorize services, arrange home health, durable medical equipment, and post-acute care. The role involves data collection for quality metrics, risk stratification, and outcomes tracking. They participate in care conferences, develop evidence-based care plans, and advocate for patient and family preferences. Administrative duties may include documentation, coding/compliance tasks, and contributing to program development, policy updates, and performance improvement initiatives.

JOB REQUIREMENTS:

EDUCATION AND EXPERIENCE

Educations and Certificates:

• Bachelor’s degree in nursing, Social Work, Healthcare Administration, or related field; or equivalent combination of education and experience.
• Certification in Case Management is preferred

Experience:

• Minimum 8 years of clinical experience in case management, discharge planning, or care coordination.
• Knowledge of insurance authorization, prior authorization processes, and community resources.

SKILLS AND PORFESSIONAL KNOWLEDGE:

• Strong assessment, care planning, and problem-solving skills.
• Knowledge of healthcare delivery systems, payer policies, and post-acute care options.
• Excellent communication, negotiation, and interpersonal abilities.
• Proficiency in electronic health records, care management software, and data analytics.
• Ability to coordinate multidisciplinary teams and facilitate transitions of care.
• Cultural competence, patient advocacy, and ethical decision-making.
• Time management, organization, and documentation accuracy.

LANGUAGE:

• Proficiency in written, read and spoken Arabic and English languages

ROLES AND RESPONSIBILITIES (But not limited to):

GENERAL ROLES AND RESPONSIBILITES:

• Assess patients’ medical, social, and functional needs to develop comprehensive care plans.
• Coordinate services across inpatient, outpatient, and community settings, including post-acute care.
• Facilitate timely discharges, transitions, and follow-up to prevent readmissions.
• Communicate with patients, families, and the care team; advocate for patient preferences.
• Manage resource utilization, ensure appropriate level of care, and monitor costs.
• Collaborate with physicians, nurses, social workers, therapists, and payers.
• Document care plans, progress notes, and outcomes; ensure regulatory compliance.

ESSENTIAL FUNCTIONS/RESPONSIBILITIES:

• Conduct comprehensive needs assessments and risk stratification.
• Create and update individualized care plans with measurable goals.
• Arrange and coordinate services such as home health, palliative care, hospice, rehabilitation, and equipment.
• Review and authorize services, tests, and procedures as required by payer policies.
• Monitor patient progress, adjust plans, and escalate concerns as needed.
• Facilitate interdisciplinary rounds and care coordination meetings.
• Provide patient and family education on care plans, medications, and self-management.
• Ensure smooth transitions of care, including discharge summaries and follow-up appointments.
• Maintain compliance with privacy, security, and regulatory requirements.
• Participate in quality improvement initiatives and data-driven program development.

Requirements added by the job poster

• Commute to this job’s location