Approvals Manager📣 إعلان

About National Medical Care and the Role

National Medical Care is seeking an Approvals Manager to join its team in Riyadh, Saudi Arabia. This full-time position is central to overseeing the review and approval processes for medical service requests, ensuring clinical appropriateness, and maintaining compliance with established guidelines and regulatory standards.

Key Functional Responsibilities

• Oversee the review and approval process of medical service requests, ensuring clinical appropriateness and compliance with medical guidelines and regulatory requirements.
• Act as a key liaison between medical providers, internal departments, and regulatory bodies to ensure timely and accurate decision-making regarding patient care approvals.
• Supervise and manage the medical pre-authorization and approval team.
• Review and assess medical service requests based on clinical guidelines, policies, and patient medical history.
• Collaborate with physicians, case managers, and claims departments to ensure accurate evaluations.
• Ensure compliance with internal protocols, payer policies, and relevant healthcare regulations.
• Train and support staff on clinical policies, coding, and documentation standards.
• Implement quality assurance processes for approval decisions and maintain high service standards.
• Resolve escalated cases and appeals in collaboration with the medical review board or medical director.
• Generate and analyze reports related to approval trends, turnaround times, and denial reasons.
• Prepare reports for hospital administration on approval process outcomes and compliance metrics.
• Conduct regular audits and assist in implementing corrective actions as needed.

Managerial Accountabilities

• Contribute to the achievement of the strategic objectives of the sector through individual performance and managing direct reports' performance.
• Set the department’s goals and objectives and ensure their cascading to reporting sections, guiding their achievement.
• Contribute to the development of the sector’s policies, procedures, and processes by providing input as advised by the direct supervisor.
• Provide direction and advice to direct reports in performing their delegated responsibilities.
• Ensure the ongoing development of department employees and assure the developmental activities of direct reports.
• Oversee the overall performance of direct reports and ensure KPIs are well communicated and monitored.
• Ensure effective identification, allocation, and utilization of the division’s resources.

Required Competencies

• Decision Making: Leverages available information related to own area of work to handle ambiguous work situations and arrive at an appropriate solution.
• Generate Ideas: Adopts new ways of conducting BAU thereby creating agility and moving away from traditional methods of operation.
• Strategic Direction: Drives external orientation and understands developments in the healthcare space that impact strategic plans for the section/sub-department.
• Develops Talent: Takes steps to build team capability by identifying learning opportunities, such as providing exposure to varied work areas, adding responsibility by way of job enrichment etc.

Key Performance Indicators

• Approval Turnaround Time: Measure the average time taken to process and approve new services or programs.
• Compliance Rate: Percentage of approvals that meet regulatory standards and guidelines on the first submission.
• Audit Findings: Number of compliance issues or discrepancies identified during internal audits over a specific period.
• Stakeholder Satisfaction: Feedback scores from internal stakeholders (*, department heads, medical staff) regarding the approval process and communication effectiveness.

Qualifications and Experience

• A minimum of 5 to 10 years of relevant experience in a similar approvals or healthcare management role.

This role offers an opportunity to lead critical approval processes within a prominent medical care provider in Saudi Arabia.