Clinical Case Manager (médecin/infirmier)

Job Overview
You are an experienced Medical Professional who can handle a large case load, multitask, and meet tight deadlines. You thrive in a fast-paced, 24/7 team environment and will provide excellent customer service via email, phone and fax.
You will have the ability to demonstrate in-depth understanding of the case management process and work well with other departments to troubleshoot and resolve issues should they arise. You must be willing to work rotational shifts including days, evenings, nights, weekends, and statutory holidays. You will also be part of an on-call rotation to handle situations outside of regular business hours.
The Clinical Case Manager will be a primary point of contact for a specialized case and claims management team requiring both medical and non-medical expertise. You will guide and provide direction to other Clinical Case Managers, Intake Specialists, and Claims Examiners utilizing your clinical knowledge by performing medical reviews and validations for Claims.
The Clinical Case Manager will be responsible for the management of their case load which entails medical management and cost containment principles. They will also perform other tasks in the realm of assistance such as coordinating and booking appointments, finding health care providers, and making travel arrangements. You will also act as a liaison between the client, patient, and service providers. The role has an afterhours component that requires the Case Manager to be on-call for any calls and medical emergencies that may arise outside of standard business hours of which will require immediate medical review and action.

Responsibilities
• Medically validate cases and determine necessity
• Summarize medical information in a clear and concise manner
• Manage a case load of patients in all phases of their treatment course until discharge and return home
• Provide assistance services to travelling members
• Communicate relevant information to all key stakeholders in a timely manner to achieve best patient outcomes in a PIPEDA and HIPAA compliant environment
• Weekly rounds or case notification reporting to clients
• Facilitate commercial or medevac repatriations
• Coordinate care and arrange billing with various service providers
• Effectively communicate and document all interactions in the case management database
• Act as the liaison between the patient, family members, multidisciplinary teams, service providers, and the client
• Confirm coverage details to service providers and members

Provide a clinical opinion and participate in the patient’s plan of care
• Be available for rotational shifts on days, evenings, nights, weekends, and statutory holidays
• Participate in an on-call rotation servicing clients outside of standard business hours
• Other duties as assigned by the KSA Operations Manager, Global Program Manager and KSA Case Management Supervisor

Qualifications and Education Requirements
• BSc or Diploma in Nursing, Doctor of Medicine, or the equivalent.
• Currently licensed as either a doctor or Nurse in good standing.
• Fluent in Arabic (verbal and written) (GCC dialect)
• Minimum 3 years’ experience working in the Kingdom of Saudi Arabia or in an Arabic-speaking position.
• Minimum 2 years of Case Management experience
• Solid clinical skills in a variety of disciplines such as oncology, transplant, and orthopedics
• Intermediate level of experience in Microsoft Office Suite
• Excellent English verbal and written communication skills
• Superior time management skills
• Resourcefulness
• Ability to work well both independently and as part of a team
• Critical thinking and decision-making skills
• Ability to work in a fast-paced and dynamic environment

Preferred Skills
• Prior experience managing cases for an International Patient Program.
• Previous experience in travel, major medical, or expat insurance within a TPA environment
• Preference will be given to those speaking a third language (German, etc.)