Job Description Summary The Case Coordination Specialist oversees complex patient cases, advises on issues with internal and external stakeholders and evaluates appropriateness of advanced levels of care utilizing evidence.-based tools to enhance the patient experience, ensure patient access and optimize cost.-effective outcomes.
Strategic Roles & Responsibilities % 10
Strategic Roles & Responsibilities
Participate in regular team meetings to discuss Case progress share updates and identify areas for Process Improvement
Coordinate with internal and external stakeholders to ensure seamless communication and efficient Case resolution
Operational Roles & Responsibilities % 90
Operational Roles & Responsibilities
Evaluate standard to complex requests from the various stakeholders based on patient benefits coverage agreements and medical necessity utilizing evidencebased tools to ensure patients receive quality costeffective care
Coordinate patient care to meet the individuals and their familys needs and ensure patient safety quality of care and costeffective outcomes
Coordinate processing of standard case review and documentation including logging tracking and resolution following established protocols and within defined service level agreements SLAs or provider contracts
Assist in maintaining uptodate patient documentation and periodic reporting ensuring information completed efficiently and accurately and is readily accessible for review and audits
Support the continuous patient care access and identifying and escalating anomalies to avoid patient care interruptions
Minimum Education Required Bachelor’s Degree in Nursing or Medicine.
Professional Certifications Required Refer to applicable JD Addendum
Years of Experience 9.-12 years of experience in relevant field
Languages English:Fully Proficient ; Arabic:Not Required
Functional Competencies
Due Diligence
Audit Reporting
Data Collection
Core Competencies
Excellence
Integrity
Accountability
Cybersecurity
Person-Centered Care
Acknowledgement Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
