Case Manager

Job Description

1. Promote quality and cost-effective interventions and outcomes

   1. Record cases information, complete accurately all necessary forms and produce statistical reports

   2. Develop effective working relations and provide feedback to administrative, medical, and RCM team throughout the entire case management process

   3. Handling case assignments, draft service plans, review case progress and determine case closures

   4. Evaluating healthcare treatments and negotiating the most cost effective options available to manage DRG

   5. Assist in timely discharge

   6. Evaluate the rigor of documentation and code assignment (during IP stay with doctors) to ensure fair remuneration

   7. Evaluate and develop training sections to avoid rejections

   8. Rejection analysis, management and coordination with responsible departments in developing collaborative strategies.

   9. Audit files and alert vulnerabilities with concerned departments.

   10. All other duties and responsibilities assigned by hospital administrator.

1. Comply with all OSH (Occupational safety and health )and infection control policies, standards and procedures and cooperate with hospital management to comply those requirements

   1. Work accordance with the documented OSH procedures and instructions, specific responsibilities

   2. Be familiar with emergency and evacuation procedures

   3. Notifying OSH Hazards, incidents, Near misses and issues and assistance with the preparation of risk assessments, incident reports

   4. Comply with Waste management procedures and policies

   5. Attend applicable OSH/Infection control training programs, mock drills and awareness programs

   6. Use of appropriate personal protective equipment and safety systems

   7. Ensure as far as reasonably practicable that any workplaces they manage or control are safe and without risks to health, safety or the environment.

   8. Ensure implementation of applicable HAAD, NMCSH OSHMS and infection control policies and standards

   9. Ensure adequate budget and resources for FMS/OSH/PCI management.

   10. Designating a Safety facilitator who will be responsible for coordinating OSH activities within the department.

   11. Regularly discuss OSH issues or matters in departmental/ management meetings

   12. Ensure provision of OSH information, training and Supervision

   13. Implement and monitor effectiveness of risk management program.

Responsibilities

• Promote quality and cost-effective interventions and outcomes.

• Record case information, complete all necessary forms accurately and prepare statistical reports.

• Develop effective working relationships and provide feedback to administrative, medical and RCM teams throughout the entire case management process.

• Handle case assignments, draft service plans, review case progress and determine case closures.

• Evaluate healthcare treatments and negotiate the most cost-effective options available to manage DRG.

• Assist in timely patient discharge.

• Evaluate the accuracy and completeness of documentation and code assignment during inpatient stays, in coordination with doctors, to ensure fair remuneration.

• Evaluate and develop training sessions to avoid rejections.

• Analyse and manage rejections and coordinate with responsible departments to develop collaborative strategies.

• Audit files and highlight vulnerabilities to the concerned departments.

• Perform all other duties and responsibilities assigned by the Hospital Administrator.

• Comply with all OSH (Occupational Safety and Health) and infection control policies, standards and procedures, and cooperate with hospital management to meet these requirements.

• Work in accordance with documented OSH procedures, instructions and specific responsibilities.

• Be familiar with emergency and evacuation procedures.

• Notify OSH of hazards, incidents, near misses and issues, and assist with the preparation of risk assessments and incident reports.

• Comply with waste management procedures and policies.

• Attend applicable OSH/infection control training programmes, mock drills and awareness programmes.

• Use appropriate personal protective equipment and safety systems.

• Ensure, as far as reasonably practicable, that workplaces under their management or control are safe and free from risks to health, safety and the environment.

• Ensure implementation of applicable HAAD, NMCSH OSHMS and infection control policies and standards.

• Ensure adequate budget and resources for FMS/OSH/PCI management.

• Designate a Safety Facilitator responsible for coordinating OSH activities within the department.

• Regularly discuss OSH issues and matters in departmental/management meetings.

• Ensure the provision of OSH information, training and supervision.

• Implement and monitor the effectiveness of the risk management programme.

Qualifications

• Sound clinical training and background.

• Medical/Allied Health graduate.

• Sound knowledge of coding, billing, auditing, approvals and clinical practices.

• Relevant coding certification.

• Auditing certification/training is preferred.

• Minimum 5 years of clinical experience in a hospital.

• 1–2 years of supervisory experience.