Job Description

As a Case Manager, you are a health care professional who will assess and manage our clients’ medical emergencies in native Spanish speaking countries in the Caribbean and the Americas. With in-house Case Management training and utilizing proprietary networks and tools, the Case Manager is able to uncover the clinical facts, facilitate access to appropriate health care, and work with local health care providers to coordinate a patient’s safe transition back home. The Case Manager will work closely with the Canadian Case Management team, as well as Intake and Assistance Coordinators in the Miami/Mexico office to ensure patients are receiving appropriate treatment, and to facilitate cost savings measures and medical transfers.

Expected Outcomes & Actions – Weighting

1. Medical Assessment and Strategy: (70%)

- Liaise with providers to obtain both verbal and written clinical information regarding patient condition and recommended treatment

- Review and monitor cases to ensure negotiation strategy is defined and executed, and current medical information is obtained.

- Ensure direct billing and facility inquiries are addressed promptly, and work with coordinators to collect required documentation including medical release and fitness to travel evaluation forms.

- Review medical records to identify any risks related to access to treatment, availability/timeliness of medical care, medical complications and prolonged admission

- Contact treating physicians to obtain medical updates, discuss the treatment plan and advocate for case management’s assessment of fitness for medical transfer or discharge.

- Document clinical summaries and case updates in English in case management software.

- Oversee and manage lateral transfers of patients to the most appropriate medical facility

- Participate in GEM multidisciplinary rounds or team huddles to support development of case action plan

- Provide “On Call” services outside of business hours

2. Cost Containment (Soft Savings): (30%)

- Liaise with LATAM negotiators regarding facility information and possible lateral transfer alternatives, and document financial strategy for each case.

- Work with LATAM negotiators and Assistance coordinators to manage inappropriate requests for guarantee of/upfront payment of services.

- Challenge proposed treatment plan.

KSA (Knowledge, Skills and Abilities/Attitudes)

• Professional and autonomous
• Excellent communications skills
• Excellent organizational and problem-solving skills
• Excellent customer service skills
• A team player
• Reliable
• Diplomatic & persuasive with good judgment

Success Measures

- The ability to take on the medical responsibility of high needs clientele with varying diagnoses

- Apply medical knowledge, follow guidelines and utilize case management tools

- Manage the relationship with treating facility and health care professionals in order to execute case management strategy without customer escalation or interruption to treatment.

- Execute lateral transfers or support the coordination of repatriation in a timely manner to ensure patient care is as seamless as possible

- The ability to adapt to a changing environment and solve problems

- Responsive to requests from colleagues and external parties

Requirements and Qualifications

• University Degree in Medicine or equivalency medical training;
• Current license in good standing with the respective regional medical governing body;
• At least two years of clinical experience in a hospital setting;
• Clear and effective communication in English and Spanish (written and verbal)
• Experience in ICU/ER an asset;
• Handle/communicate and exchange sensitive and confidential information in a professional manner;
• Excellent written and verbal communication skills with proven ability to communicate medical terms/concepts to diverse groups, including medical professionals and the general public;
• Able to handle fluctuating work volumes in a fast paced, customer focused environment;
• Able to successfully work independently and in a team;
• Proven ability to prioritize work responsibilities to achieve best possible outcomes;
• Basic understanding of travel insurance, insurance terminology and case management is an asset;
• Strong computer skills (Windows, Excel, typing);
• Able to work various shifts and days of the week as required.

We offer you

Gloabl Excel offers a competitive salary, benefits above the law and an annual bonus according to performance.