Job Description

Job Description

The Corporate Case Manager is responsible for supervising, guiding, and auditing Case Management activities across all inpatient facilities. This includes establishing standardized CM workflows, monitoring facility KPIs, reviewing DRG variances, analysing utilization metrics, and ensuring best practices in documentation and care coordination. The role collaborates with facility CM Leads, coding teams, physicians, revenue cycle units, and clinical leadership to ensure compliance, reduce financial leakage, and enhance DRG performance.

Responsibilities

Corporate Oversight & Governance

• Oversee Case Management practices across all NMC inpatient facilities.
• Ensure consistent execution of case management workflows aligned with corporate RCM expectations.
• Conduct regular performance reviews and issue directives to maintain standardization across all facilities.

Standardize Case Management Policies and Tools

• Develop, update, and enforce unified Case Management policies and procedures for all facilities.
• Ensure the use of standardized tools such as: admission review templates, DRG variance logs, daily CM activity checklists, and physician query documentation.
• Establish clear expectations for documentation quality across the Case Management function.

Monitoring of DRG Performance & Revenue Integrity:

• Review facility-level DRG shifts, LOS outliers, case profitability, and CC/MCC documentation patterns.
• Identify opportunities for improved DRG capture, better documentation support, and early engagement of CDI and coding teams.
• Ensure Facility Case Managers proactively manage high-cost and complex cases.
• Utilization Management & Compliance

Facility Performance Monitoring & KPI Management

• Define corporate KPIs for Case Management (LOS variance, query impact, DRG variance, high-cost case review, etc.).
• Track monthly data from all facilities and issue performance dashboards to RCM leadership.
• Highlight facilities requiring corrective action and support them in closing gaps. 

Continuous Education & Best Practice Sharing

• Conduct training programs for Case Managers on DRG understanding, documentation standards, LOS management, and discharge planning.
• Escalation & Risk Management: Act as the first point of escalation for complex case management issues from any facility.
• Partner with corporate Coding, CDI, Utilization Review, and Billing teams to address documentation issues and denial trends.
• Identify system-wide process gaps and recommend improvements for the Case Management function.

Qualifications

Education and Certification

• Bachelor of Medicine (MBBS), Nursing or paramedical filed (mandatory)
• Preferred: Certification in Coding ( AHIMA or AAPC)

Knowledge and Skills

• Strong understanding of Case Management processes, DRG reimbursement, and utilization management.
• Knowledge of UAE insurance regulations, DRG rules, and payer medical necessity criteria.
• Strong analytical, problem-solving, and decision-making skills.
• Proficiency in EMR, HIS, and data reporting tools. Data-driven decision-making with strong analytical and reporting skills.
• Excellent communication and interpersonal skills for engaging with clinicians and leadership teams.
• Ability to manage multi-facility operations with structured oversight. 

Group Case Manager benefit from having experience/competency in:

• DRG validation, variance analysis, and CMI optimization across multiple facilities to improve reimbursement accuracy.
• Utilization management and LOS benchmarking, ensuring medical necessity and efficient patient flow.
• Clinical documentation improvement (CDI) including physician queries, CC/MCC capture, and documentation gap identification.
• Managing high-cost, complex, and outlier cases, with the ability to assess financial impact and drive corrective actions.
• Interpreting UAE payer rules and denial trends, and implementing strategies to reduce avoidable denials.
• Developing and monitoring group-level KPIs, creating dashboards, and reporting performance trends to corporate leadership.

Experience

• 5+ years in Case Management or Utilization Management, with at least 2 years in a supervisory or multi-facility role.
• Strong understanding of DRG reimbursement, medical necessity criteria, inpatient documentation, and discharge planning.