job description
Join IHH Healthcare, a global leader in healthcare services, as a Clinical Case Manager in beautiful Bali. In this pivotal role, you will serve as the bridge between medical providers, patients, and insurance entities, ensuring that all health insurance claims are medically validated for necessity and appropriateness of planned treatments.
Your expertise will directly impact patient care by confirming that proposed medical interventions align with clinical guidelines, insurance policies, and ethical standards. This position offers a unique opportunity to contribute to a high-impact, patient-centered healthcare environment while working in one of the worldās most sought-after destinations.
As part of our dynamic team, you will collaborate with multidisciplinary professionals to streamline case management processes, enhance operational efficiency, and uphold the highest standards of medical integrity. Baliās vibrant culture and serene landscapes provide an inspiring backdrop for a fulfilling career in healthcare administration.
Responsibility
- Conduct thorough medical reviews of health insurance claims to assess the clinical necessity of proposed treatments, procedures, or hospitalizations.
- Collaborate with healthcare providers, insurers, and patients to gather and verify medical documentation, ensuring compliance with policy terms.
- Evaluate treatment plans against evidence-based guidelines and insurance coverage criteria to determine approval or denial.
- Prepare detailed case reports and recommendations for internal stakeholders, including underwriters and medical directors.
- Facilitate communication between patients and insurers to clarify medical justifications and resolve discrepancies.
- Monitor and track case progress, ensuring timely processing and adherence to regulatory and organizational timelines.
- Identify opportunities to improve case management workflows and contribute to process optimization initiatives.
- Stay updated on medical advancements, insurance policies, and healthcare regulations to ensure accurate and compliant decision-making.
Qualifications
- Bachelorās degree in Nursing, Medicine, or a related healthcare field (Masterās degree preferred).
- Minimum 3 years of experience in clinical case management, medical review, or a similar role within healthcare or insurance.
- Active licensure or certification (e.g., RN, CCM) in a relevant healthcare discipline.
- Proven ability to interpret medical records, diagnostic reports, and treatment plans with precision.
- Strong analytical and problem-solving skills with a keen attention to detail.
- Excellent communication and interpersonal skills to liaise effectively with diverse stakeholders.
- Proficiency in healthcare IT systems and case management software.
- Fluency in English (additional languages, such as Bahasa Indonesia, are a plus).