Case Manager

Role Overview

Case Manager at NMC Healthcare in Al Ain.

Role Purpose

The Case Manager ensures accurate clinical documentation, optimal coding and billing practices, efficient claims management, and continuous provider education to maximize revenue cycle performance and maintain compliance with medical necessity and coding standards.

Key Responsibilities

Documentation & Gap Analysis

• Identify missing clinical data and communicate directly with the attending physician for timely completion.
• Validate clinical evidence to ensure services meet medical necessity criteria.
• Ensure case documentation accurately captures patient risk to justify the optimal case mix.
• Review outpatient medical records for compliance with current Evaluation & Management (E&M) documentation guidelines.

Coding & Billing Optimization

• Ensure accurate coding of all services to prevent down-coding and revenue leakage.
• Prevent missed revenue leakages by ensuring all services rendered are coded accurately.

Claims & Denial Management

• Analyze the root causes of insurance claim rejections and denials.
• Conduct random audits of medical records across departments to identify trends and documentation gaps.
• Recommend corrective actions to minimize recurring claim denials.
• Support billing optimization through accurate documentation and coding practices.

Provider Education & Quality Improvement

• Educate physicians and clinical departments on documentation and coding best practices.
• Develop and deliver training programs to address recurring documentation and billing errors.
• Advise doctors and departments on best-practice trends, optimal resource utilization, and controlling outlier expenses.
• Provide continuous feedback to improve clinical documentation quality and coding accuracy.
• Promote appropriate resource utilization and reduction of unnecessary costs.

Occupational Safety & Health (OSH) - General Responsibilities

• Implement and comply with OSHAD-SF and NMC Al Ain Occupational Safety & Health Management System (OSHMS/EHSMS) policies, procedures and SOPs.
• Report all hazards, incidents, accidents and near misses in accordance with the incident reporting protocol.
• Comply with all applicable OSHMS/EHSMS policies, standards and workplace procedures.
• Attend mandatory OSH/EHS training and apply safe work practices.
• Take reasonable care of personal health and safety and that of others affected by work activities.
• Wear and maintain all required Personal Protective Equipment (PPE).
• Protect hospital equipment and property from misuse or damage.
• Follow all safety instructions, warning signs and emergency procedures.
• Adhere to all task-specific OSH/EHS requirements.

Occupational Safety & Health (OSH) - Leadership Responsibilities

• Lead the development, implementation and continuous improvement of the Occupational Safety & Health Management System.
• Assume overall responsibility for Occupational Health & Safety across all NMC Al Ain facilities.
• Ensure adequate OSH resources, including budget, manpower and equipment.
• Approve and support OSH/EHS policies, procedures, programs and annual plans.
• Establish and maintain a clear Occupational Safety & Health Policy and ensure it is reviewed annually.

Qualifications & Experience

• Medical or Allied Health graduate degree.
• Minimum 5 years of clinical experience in a hospital setting.
• Minimum 2 years of supervisory or team leadership experience.
• Internationally recognized Medical Coding certification (CPC, CCS, CCS-P, CIC, COC, AHIMA or AAPC certification).
• Auditing certification or formal audit training is preferred.

Skills & Competencies

• Strong clinical training and healthcare background.
• Strong knowledge of medical coding, billing, clinical auditing, insurance approvals and revenue cycle management.
• Proficient in EMR/HIS systems, medical documentation standards and coding guidelines (ICD, CPT/HCPCS, as applicable).
• Excellent analytical and problem-solving skills.
• Excellent communication skills.
• Strong organizational skills with the ability to manage multiple priorities while maintaining accuracy and compliance.