Manager - Medical Pre Authorisation
- المدينة
- الرياض
- نوع العمل
- حضوري
- تاريخ النشر
- لم تذكره جهة العمل
- المجال
- القطاع الصحي
عن الوظيفة
Ensure clinically appropriate, evidence-based preauthorization decisions through effective utilization management, regulatory compliance, and provider engagement, while safeguarding patient outcomes, enhancing customer experience, and optimizing healthcare resource utilization.
Medical Cost & Service Management • Apply evidence-based medicine, clinical guidelines, and policy terms during preauthorization review. • Ensure appropriate utilization of healthcare services while preventing unnecessary costs. • Support cost-containment initiatives through effective medical adjudication and utilization management.
اقرأ الوصف كاملاً
Quality Medical Decision & Patient Safety · Ensure clinically sound and consistent medical decisions. • Monitor decision quality and adherence to medical protocols. • Promote provider satisfaction through effective communication and partnership management.
Business Support & Stakeholder Management • Manage and escalate high-value, complex, or critical cases when required. • Participate in complaint resolution and support business continuity efforts. • Maintain effective communication with internal and external stakeholders. • Report operational risks and critical incidents in a timely manner.
Compliance, Governance & Risk Management • Ensure adherence to Bupa policies, medical protocols, and regulatory requirements. • Comply with CHI regulations and governance standards. • Identify, escalate, and report suspected fraud, waste, abuse, and anti-selection activities. • Support audit readiness and compliance monitoring activities.
Job Details Posted Date: 2026-09-10 Job Location: Saudi Arabia - Riyadh Job Role: Other Preferred Candidate Career Level / Band: Mid Career Minimum Degree: Bachelor's degree