MetLife Hiring for Case Management Coordinator Job at Dubai Full Time

Job Purpose:

Analyze & investigate cases and identify opportunities for alternate cost effective solutions for patients without jeopardizing the quality of care. Follow up with patients to enhance quality of care and satisfaction and promote continuity of care and cost effectiveness. Ensure treatment is in line with medical parameters and curtail abuse of care and length of stay.

Key Responsibilities:

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  ROI & Customer Centricity: Evaluate the appropriateness, medical need and efficiency of health care service procedures. Facilitate according to the guidelines under the provisions of applicable healthcare benefits thus resulting in financial appropriateness for the organization. Monitor and intervene where required to achieve cost efficient and quality healthcare options for patients. Arrange extra discounts on high cost pharmacies and medical consumables. A savings target is applicable for this role.

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  Internal Partnership: Feedback from the results of case management to pre-approval team and adjudicators to strategically identify abusive providers and development of state of art facilities for specific high cost surgeries or high cost long term care admissions. A feedback mechanism for network team on the abuse of providers to provide value at the time of re-negotiating contracts and feedback to FWA team to highlight such providers

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  P & L: Identification of alternate cost effective methods for hospitalizations and high risk cases thus resulting in a positive impact on P & L. Similarly identification of cost effective methods for claims and pre approval for specific procedures

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  Strategy: Responsible to identify doctors who will be the choice if any case is to be referred, to get the best possible outcome and cost effectiveness.

Qualifications & Skills:

• Medical graduate degree

• 3- 5 years of experience with pre-approval and case management and have a strong knowledge of medicine to challenge providers

• Possess skills to develop creative solutions for medical quality management

• Ability to develop a feedback mechanism for different stakeholders

• Strong communication skills