The role of the new entrant Case Coordinator is to coordinate the multidisciplinary team, and any other appropriate and accredited healthcare provider in the provision of quality patient care, under the guidance and supervision of the Senior Case Coordinator

The role includes advocacy & education, facilitation, transition & financial management, outcomes & psychosocial management in order to promote quality, safe and timely transition through the healthcare system. 

Under supervision and guidance from the Senior Case Coordinator, the case coordinator will coordinate appropriate providers and access appropriate services to progress the patient’s episode of care in a timely manner. 

Until competency level has been achieved as per competency evaluation, the Case Manager will develop patient care plans to include:

• Correct Level of care placement- Utilization Management
• Care Facilitation along the Continuum of Care, monitoring against Clinical Pathway, and facilitation of transition plans
• Proactive Discharge Planning
• Facilitation of accurate medical documentation and health insurance documentation
• Facilitation of Resource Utilization- ensuring the available funding meets the clinical needs
• Links the physician staff with finance

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• Actively participate in regular communication and feedback with Senior Case Coordinator.
• Under guidance, apply appropriate Evidence Based Medical Necessary screening criteria in support of admission and continued stay reviews and communicates with payers as necessary.
• Under supervision, coordinate/ delegate to multidisciplinary team members, to ensure patient care progression throughout the continuum, to ensure that necessary services are provided at the most appropriate level of care and there is a smooth progression of the patient throughout the healthcare system by:

1. Working collaboratively and maintaining active communication with physicians, nursing and other appropriate members of the multidisciplinary team to a cost effective, timely, and appropriate patient management.
2. Proactively identifies and resolves variances to clinical pathway and obstacles to discharge.
3. Seek consultation from appropriate disciplines / departments as required to expedite care and facilitate discharge.

• Learns and comprehends, working knowledge of patient’s benefits under Insurance contract to ensure patient care is rendered to the maximum stipulation but does not exceed the providers’ provision for cost of care and collaborations with team to obtain documentation to support medical necessity.
• Monitors the patient’s progress, consulting with Senior Case Coordinators on appropriate intervention as necessary to ensure that the plan of care and services provided are patient focused, quality, efficient and cost effective.
• Seeks consultation with the Senior Case Coordinator to facilitate and coordinate the following in a timely manner:

1. advocacy & education of the patient, family and relevant others by appropriate care team      members
2. transition management to ensure the patient is transitioned to the appropriate level of care
3. monitoring and intervening as necessary to achieve desired goals and outcomes for both the    patient and the hospital
4. early assessment and intervention (once deemed competent) to address psychosocial needs including patient, family and community and collaborates with Social Workers as appropriate

• communicate closely with Utilization & financial managers regarding insurance and other financial issues to ensure appropriate reimbursement for services (once deemed competent)
• Completion of all required documentation in patient medical file.
• Obtains and maintains appropriate releases of information 
• Completes Case Management and quality screening for assigned patients (once deemed competent)
• Under supervision of Senior Case Coordinator, applies approved utilization acuity criteria to monitor appropriateness of admissions and continued stay and documents findings based on department standards. 
• Monitors length of stay and resource use on an ongoing basis and discusses trends with Senior Case Manager.
• Uses quality screens to identify potential issues, discuss with Senior Case Manager appropriate planning and interventions.   

• Participates in clinical performance improvement activities
• Assists in the collection and reporting of indicators including LOS, excess days, resource utilization, and readmission rates. 
• Gather, interpret, and use data to identify problems and trends and to demonstrate outcomes and cost-effectiveness 
• Participates in Quality Assurance programs within the clinical care setting
• Assists in development of CQI processes for Case Management
• Actively participates in the development and implementation of Case Management projects including Clinical Pathways, Quality Improvement tools, data analysis and variance reporting
• Supports   physicians in relation to Clinical Documentation impacting Medical Necessity, Case Mix Index, and Severity of Illness

• Planning, teaching, supervising and counseling (as required) regarding physical care measures to promote improvement/recover, symptom/complication management, expected disease progression, social/emotional care and community resources

• Keeping abreast of Professional Case Management Practice development and updating requirements.

• Facilitating patient education based on identified learning needs of the patient and/or those providing care and documents appropriately

Provide regular details on long term and outlier cases

Participate in the daily clinical round with physician 

Provide, monitor and track all non-network admissions and refer them to their network when appropriate

Provide , monitor and track all private and non-private post-acute care referrals

Participate in mentoring new staff joining the case management department

• Complying consistently with facility policies, procedures and practices and ensuring alignment with SEHA facilities policies

• Completing and maintaining regulatory requirements including: licensure and certification and other mandatory training within established time frames

• Maintaining confidentiality with regards to any information exchanged or received in the current capacity of role in accordance with facility policy

Promoting Customer Service standards

• Assuming the role of a brand ambassador for the facility and promoting a customer focused philosophy in dealing with any stakeholders 

• Maintaining positive and effective working relationships within the department/division and also with other departments/sections within the facility 

• Performing any other duties as may be assigned relevant to the basic responsibilities of the role 

Adhering to requirements of the Occupational Health and safety guidelines and infection control guidelines

Understanding and adhering to emergency preparedness plans/policies

Recognizing the necessity of continuously developing skills and acquiring additional knowledge appropriate to the position

Dressing appropriately to meet the expectations of the specific work area and in alignment with the Occupational Health and Safety policies

Building key partnerships within the organization for pursuing client-centered, comprehensive, integrated systems of care

Complying with any regulations related to mentoring, training and development of UAE nationals staff

Required:

• Bachelor degree in Nursing OR
• Associate degree in Nursing from Canada or USA with minimum two (2) years course duration AND
• Successful completion of the National exam:
• USA: NCLEX – RN
• Canada: Privincial Licensing Exam OR
• Diploma in Nursing and Midwifery of minimum three and half (3 ½ ) years course duration OR
• Diploma in Nursing of minimum three (3) years course duration

Required: 

Case Management Certification Credential from international accreditation body

ie. (ANCC, ACMA, CMSA, AACM...) For external Hiring only

Desired:

Case Management Certification Credential from international accreditation body

ie. (ANCC, ACMA, CMSA, AACM..) For existing staff and internal Hiring.