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- Tasks: Manage healthcare resources efficiently while ensuring quality services and conducting utilization reviews.
- Company: Join a dynamic hospital team in Abu Dhabi focused on improving patient care and outcomes.
- Benefits: Enjoy relocation support, competitive salary, and opportunities for professional development.
- Why this job: Make a real impact in healthcare while working in a fast-paced, collaborative environment.
- Qualifications: Must have 5 years of nursing experience and 1 year in case management; RN license required.
- Other info: Fluency in English and proficiency in Microsoft Office are essential.
The predicted salary is between 36000 - 60000 £ per year.
Utilization Review Case Manager (relocation required to Abu Dhabi, UAE)
JOB SUMMARY
The Case Management team shall operate in an effort to deliver the most efficient, effective allocation of health care resources, while maintaining the maximal quality of services provided.
The evidenced-based clinical decision support criteria will be used for the evaluation of medical necessity with relation to admission and continued stay.
The Utilization Review (UR) case manager (CM) has well-developed knowledge and skills in areas of utilization management (UM), medical necessity, and patient status determination. This individual is responsible for performing a variety of concurrent and retrospective UM-related reviews and functions and for ensuring that appropriate data is tracked, evaluated, and reported. This individual monitors the effectiveness/outcomes of the UM program, identifying and applying appropriate metrics, evaluating the data, reporting results to various audiences, and designing and implementing process improvement projects as needed. This individual identifies, develops, and provides orientation, training, and competency development for appropriate staff and colleagues on an ongoing basis. This individual leads and/or actively participates in process improvement initiatives, working with a variety of departments and multi-disciplinary staff. The UR CM effectively and efficiently manages a diverse workload in a fast-paced, rapidly-changing regulatory environment. The UR CM is a member of and provides support to the hospital’s UR Committee. He/she collaborates with multiple leaders at various levels for the purpose of supporting and improving the UM program.
PRIMARY JOB DUTIES AND RESPONSIBILITIES
- Conduct admission and concurrent reviews on every admitted patient according to evidence-based criteria, contractual agreements required by payors.
- Conduct evidence-based admission review based on appropriateness and medical necessity of admissions, assurance that patient is placed in the correct level of care.
- Conduct Initial Review IR for all admitted patients through ED, clinics, transfer center, elective admissions, direct admission, and PACU.
- Notify the unit CM if a patient does not meet admission criteria and include unit CM in communication with the physician advisor.
- Document avoidable days when identified.
- Conduct secondary review on the second day of admission for those who did not meet admission criteria.
- Perform initial reviews when there is a change in level of care to a higher level.
- Provide clinical consultation regarding UM to physicians and other colleagues.
- Provide ongoing education to inpatient case managers, ED case managers, and other colleagues related to UM, medical necessity, patient status, non-coverage notifications, and other areas as requested.
- Participate in the orientation of new caregivers in the CM department.
- Develop and provide individualized UM-related education as needed.
QUALIFICATION & EXPERIENCE REQUIREMENTS
Education
- Minimum of 5 years of nursing experience
- Minimum of 1 year in case management
Certification and Licensure
- RN DOH license
Professional Membership
- CM certification
Job Specific Skills and Abilities
- Proficiency with Microsoft Office suite
- Fluency in written and spoken English
Seniority level : Associate
Employment type : Full-time
Job function : Health Care Provider
Industries : Hospitals and Health Care
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Utilization Review Case Manager (relocation required to Abu Dhabi, UAE) employer: Cleveland Clinic Abu Dhabi
Contact Detail:
Cleveland Clinic Abu Dhabi Recruiting Team
StudySmarter Expert Advice 🤫
We think this is how you could land Utilization Review Case Manager (relocation required to Abu Dhabi, UAE)
✨Tip Number 1
Familiarize yourself with the healthcare regulations and utilization management practices specific to Abu Dhabi. Understanding the local healthcare landscape will not only help you in interviews but also demonstrate your commitment to relocating and adapting to a new environment.
✨Tip Number 2
Network with professionals already working in the UAE healthcare system, especially those in case management roles. Engaging with them can provide insights into the job market and may even lead to referrals that could enhance your application.
✨Tip Number 3
Stay updated on the latest trends and best practices in utilization management. Being knowledgeable about current evidence-based criteria and metrics will position you as a strong candidate who is ready to contribute effectively from day one.
✨Tip Number 4
Prepare for potential interview questions by practicing scenarios related to case management and utilization review. Demonstrating your problem-solving skills and ability to handle complex cases will showcase your readiness for the role.
We think you need these skills to ace Utilization Review Case Manager (relocation required to Abu Dhabi, UAE)
Some tips for your application 🫡
Understand the Role: Make sure you fully understand the responsibilities and qualifications required for the Utilization Review Case Manager position. Familiarize yourself with the key duties such as conducting admission reviews and providing clinical consultation.
Highlight Relevant Experience: In your application, emphasize your nursing experience and any specific case management roles you've held. Mention your familiarity with utilization management and medical necessity to align with the job requirements.
Showcase Your Skills: Demonstrate your proficiency with Microsoft Office and your ability to communicate effectively in English. Provide examples of how you've managed diverse workloads in fast-paced environments, as this is crucial for the role.
Tailor Your Application: Customize your CV and cover letter to reflect the specific skills and experiences that match the job description. Use keywords from the job posting to ensure your application stands out to hiring managers.
How to prepare for a job interview at Cleveland Clinic Abu Dhabi
✨Showcase Your Clinical Knowledge
Be prepared to discuss your understanding of utilization management and medical necessity. Highlight specific examples from your past experience where you successfully conducted admission reviews or managed patient statuses.
✨Demonstrate Process Improvement Skills
Share instances where you've led or participated in process improvement initiatives. Discuss the metrics you used to evaluate outcomes and how you implemented changes based on data analysis.
✨Emphasize Collaboration Experience
Since the role involves working with various departments and multi-disciplinary teams, be ready to talk about your experience collaborating with different healthcare professionals. Provide examples of how you effectively communicated and supported team goals.
✨Prepare for Scenario-Based Questions
Expect scenario-based questions that assess your decision-making skills in a fast-paced environment. Practice articulating your thought process when faced with challenges related to patient admissions and care level determinations.
