Apply: Case Management Specialist

Description: Case Management Specialist

The dedication of talented and caring health care professionals drives the delivery of high quality, cost-effective products and services. They make it possible for members to get the right health care treatment for their needs.

Family Summary:

Develop, implement, support, and promote Health Services strategies, tactics, policies, and programs that drive the delivery of quality healthcare in a cost-effective manner to establish a competitive business advantage. Health Services strategies, policies, and programs are comprised of utilization management, quality management, network management, and clinical coverage and policies.

Position Summary:

The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual’s benefit plan and/or health needs through communication and available resources to promote optimal cost-effective outcomes.

Fundamental Components & Physical Requirements:

Assessment of Members/Claimants: Using clinical tools and information/data review, conducts comprehensive assessments of referred member's needs/eligibility and determines the approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services.

Enhancement of Medical Appropriateness & Quality of Care:

• Application and/or interpretation of applicable criteria and guidelines, standardized care management plans, policies, procedures, and regulatory standards while assessing benefits and/or member’s needs to ensure appropriate administration of benefits.
• Using a holistic approach consults with supervisors, Medical Directors and/or others to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain a multidisciplinary review to achieve optimal outcomes.
• Identifies and escalates quality of care issues through established channels.
• Utilizes negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs.
• Monitoring, Evaluation, and Documentation of Care: Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Background Experience Desired:

• Healthcare and/or managed care industry experience.
• Proven clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care.

Education and Certification Requirements:

• Clinically Trained with Degree or recognized designation in western Medicine / Nursing or other western medical disciplines.
• Educated to degree level in a relevant discipline.
• Additional information:
• Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment
• Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding
• Effective communication skills, both verbal and written in English (must)

Reg No. R1443092
BeathChapman Pte Ltd
Licence no. 16S8112