Member Clinical Case Manager
The primary goal of this role is to support Bupa Global members with navigating the US healthcare system and helping them make the appropriate decisions regarding their medical needs for inpatient & complex cases. The aim will be to deliver an evidence and value-based healthcare experience including maximazing the utilization of cost efficient centres of excellence.
In addition, this role will collaborate and work closely with our global clinical operations team to leverage knowledge, capability and process compliance as well as with our US Service Partners, who perform provider case management
- To communicate pro-actively and effectively with the members and their family; to collaborate with internal & external clinical & non clinical colleagues, in order to ensure optimal health care outcomes in the most cost efficient manner.
- To manage the holistic assessment, planning, coordinating, monitoring and evaluation of outcomes and activities necessary to facilitate member access to healthcare services in the US for Inpatient and Complex cases.
- To educate members around the benefits of using the most cost & quality efficient providers; to help them navigate the US healthcare system & understand the healthcare pathways available to them and within the confines of their plan benefits.
- To input accurate and timely clinical case information, actions and savings achieved as a result of case management activities, into agreed database(s). · To identify opportunities to reduce future claim expense for Bupa Global.
- To follow established regulatory guidelines, policies, and procedures in relation to member interventions and documentation of activities related to the members’ care and progress across the continuum of care.
The Ideal Candidate
- Bachelor’s degree in nursing or RN certification
- At least 5 years of solid experience in Acute Care / Managed Care / Case Management in US IPMI environment.
- Excellent knowledge of US Medical Management tools & guidelines
- Excellent interpersonal skills and ability to work with a team is a must · Respects diversity and embraces cultural difference
- Highly customer focussed and able to place customer’s health and benefit is No. 1 priority balanced with strong cost containment in tandem.
- Understand the business commitment to meet deadlines, turn-around times and evidencing cost containment is required.
- Proficient communication skills in English, a second language (Mandarin / Arabic) would be advantageous
** Please assure to add an updated copy of your Resume to your application. Applications or profiles without an updated Resume will not be considered. **
** Por favor, asegúrese de añadir una copia actualizada de su currículum a su solicitud. No se tendrán en cuenta las solicitudes o perfiles que no tengan un currículum actualizado. **