Manager Utilization and Clinical Review/Case Management - UCR

PRS Medical - ERN Group

Job Description

Job Title: Manager Utilization and Clinical Review/Case Management - UCR
Al Ain Hospital, Abu Dhabi
Department: Utilization and Clinical Review/Case management (UCR)
The Role:
Provide management and leadership in discharge planning process.
Reports To:
Medical director/ Matrix organization with Head of Patient Services

Responsible for:
All staff allocated to the Section

Job Summary:
Developing and implementing discharge planning policy
Developing discharge planning and utilization management policies.
Leading change management to support implementation of the policy.
Improve information flow between hospital units, Insurance Centre.
Improve financial information flow to the patient, their families and members of the hospital multidisciplinary team.
Manages the collection, measurement and presentation of data required for monitoring of utilization quality indicators.
Oversees all facets of the daily operation of the organizational unit, ensuring compliance with applicable hospital and SEHA policies and procedures, International standards, Governmental laws and Third Party reimbursement Systems requirements.
Performs other related duties as assigned or requested
Education, Licensure
A Medical/Nursing Degree from a recognized University.
Professional experience
Minimum of ten (10) years experience (with a minimum of 3 years experience in Utilization/Case Management) in a large hospital or health management organization with demonstrated skills in critical care service areas such as;
Intensive care, Emergency, Trauma or Operating Room
Familiarity with application of insurance industry standards, preferably in Tertiary Health Care setting.
Familiarity with application of Hospital Information systems, preferably in Tertiary Health Care setting

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