Aetna Case Manager in Dubai, United Arab Emirates

Req ID: 41979BR

About Aetna

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.

Position Summary

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.

    Background/Experience Desired

  • 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