Officer, Case Management

About the role

The Officer, Case Management supports Daman’s case management function by evaluating medical cases, coordinating care, and ensuring compliance with medical policies and regulations. The role involves collecting and analysing case data, reporting findings and facilitating communication between members, providers and internal teams to optimise patient outcomes.

Key responsibilities

• Obtain and review all necessary clinical information to ensure appropriate utilisation of resources for medical service approvals.
• Communicate and coordinate with healthcare providers to minimise fragmentation in patient care.
• Assist members in navigating the healthcare system to achieve timely, high‑quality medical outcomes.
• Research and gather medical and financial information to support case evaluations and cost assessments.
• Document patient‑care information in the recording system for team accessibility.
• Issue and modify authorisations as required to facilitate necessary medical services.
• Conduct concurrent medical record reviews using specific indicators to monitor patient progress and update care plans.
• Report emerging trends in provider behaviour to stakeholders for investigation and corrective action.
• Verify compliance with internal policies and external healthcare regulations when processing approvals.
• Meet with internal teams to ensure seamless coordination and resolution of case‑related issues.
• Summarise case details for reporting, ensuring clarity and accuracy.
• Observe industry best practices and regulations to maintain high‑quality case‑management standards.
• Monitor medical service utilisation to identify trends and recommend improvements in authorisation processes.

Required profile

• Bachelor’s degree in Healthcare Management, Nursing, Medicine or a related field; Master’s degree preferred.
• 0‑2 years of experience in case management, healthcare operations or medical insurance, with expertise in reviewing medical cases, coordinating services and collaborating with providers.