Job Description

Looking for Case Manager (with uae experience ) for Yas clinic Khalifa city

Job Summary

Responsible for coordinating inpatient and outpatient cases, obtaining insurance approvals, monitoring utilization, ensuring accurate clinical documentation, facilitating discharge planning, and supporting the hospital’s revenue cycle through compliance with UAE insurance regulations and payer requirements.

Key Responsibilities

* Coordinate patient care with physicians, nurses, and allied health professionals.
* Obtain pre-authorizations, concurrent approvals, and extensions from insurance companies and TPAs.
* Review medical necessity and ensure compliance with payer guidelines.
* Monitor patient length of stay (LOS) and resource utilization.
* Prevent claim denials by ensuring complete and accurate clinical documentation.
* Collaborate with coding, billing, and finance teams for timely claim submission.
* Track pending insurance approvals and escalate delayed cases.
* Coordinate discharge planning and continuity of care.
* Participate in utilization review and clinical audits.
* Prepare case management and utilization reports.
* Ensure compliance with DHA, DOH, MOHAP, and insurance regulations.