Coordinates the care and services delivered to contracted patients accepted
for treatment at KFSH&RC, to ensure effective utilization and monitoring of
health care resources, provides a leadership role within the interdisciplinary
team to achieve desired clinical, financial and resource outcomes within
defined time frames.
1.Maintains up-to-date knowledge of current practice, accreditation and
industry standards of utilization review and case management, in order to
assess the continuum of care and patient care processes of contracted
patients.
2.Compares inpatient medical records to establish criteria and confers with
Health Care professional to determine appropriate length of stay.
3.Uses ARAMCO program called SAHL to view data and act accordingly as well as
enters ARAMCO patient 's data.
4.Assesses, develops, implements and monitors a comprehensive plan of care
through an interdisciplinary team approach in conjunction with the patient and
the family within the hospital setting.
5.Collaborates with the health care team, assesses the appropriateness of the
level of care, diagnostic testing and clinical procedures, quality and
clinical risk issues and documentation of medical record completeness.
6.Reports variances through established quality improvement processes.
7.Communicates continually with patients, families, medical staff, caregivers
and thirty party guarantors as necessary.
8.Facilitates or provides necessary patient and family education, prior to
admission, during hospitalization and after discharge as indicated.
9.Analyses outcome data that includes, but is not limited to readmission,
unplanned discharge and patient satisfaction and makes recommendation for
change within a designated service line.
10.Orients health care staff to the Business Centre Clinical Representative
duties.
11.Initiates/participates in strategies to promote continuity of care across
the care continuum such as Clinical Pathways or Care Map Systems.
12.Matches patient needs to available resources and works as patient's
advocate.
13.Follows all Hospital-related policies and procedures.
14.Participates in self and other's education, training and development, as
applicable.
15.Performs other related duties as assigned.
Bachelor 's or Associate Degree/Diploma in Nursing is required.
Four (4) years of acute hospital nursing experience within specialized service
area with Bachelor 's Degree or six (6) years of similar requirements with
Associate Degree/Diploma is required.
Graduate from an Accredited School of Nursing, Current Registered Licensure
from country of origin required.
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