Aetna Case Manager in Dubai, United Arab Emirates
Req ID: 41979BR
Aetna International is a leading provider of international expatriate private medical insurance and health management solutions. We have over 1000 staff and growing every day. Our customer base is over 123,000 members located worldwide; and we have more than 71,000 health care professionals and facilities worldwide in the offices in all the major regions of the world.
The Case Manager utilizes a collaborative process of assessment,planning, facilitation and advocacy for options and services to meet anindividual s benefit plan and/or health needs through communication andavailable resources to promote optimal, cost-effective outcomes.
Fundamental Components Requirements
Assessment of Members/Claimants through the useof clinical tools and information/data review, conducts comprehensiveassessments of referred member's needs/eligibility and determines approach tocase resolution and/or meeting needs by evaluating member's benefit plan andavailable internal and external programs/services.
Enhancement of Medical Appropriateness &Quality of Care:
- Application and/or interpretation of applicablecriteria and guidelines, standardized case management plans, policies,procedures, and regulatory standards while assessing benefits and/or member sneeds to ensure appropriate administration of benefits.
Using holistic approach consults withsupervisors , Medical Directors and/or others to overcome barriers to meeting goalsand objectives; presents cases at case conferences to obtain multidisciplinaryreview in order to achieve optimal outcomes.
Identifies and escalates quality of care issuesthrough established channels
Utilizes negotiation skills to secureappropriate options and services necessary to meet the member s benefits and/orhealthcare needs.
Monitoring, Evaluation and Documentation ofCare.
Utilizes case management and quality managementprocesses in compliance with regulatory and accreditation guidelines andcompany policies and procedures.
Proven clinical practice experience, e.g.,hospital setting, alternative care setting such as home health or ambulatory care.
Healthcare and/or managed care industryexperience.
Education and Certification Requirements
- Clinically trained with Degree or recognizeddesignation in western Medicine / Nursing or other western medical disciplines.
Job Function: Health Care