Manager Medical Pre Authorisation

📣 إعلان

منذ ساعة واحدة تقريباً

	نوع العقد	دوام كامل
	طبيعة الوظيفة	بالموقع
	الموقع	الرياض

وصف الوظيفة

About the Role

Bupa Arabia is seeking a Manager - Medical Pre Authorisation to join their team in Riyadh. This full-time position is responsible for ensuring clinically appropriate and evidence-based preauthorization decisions. The role focuses on effective utilization management, regulatory compliance, and engaging with providers to safeguard patient outcomes and optimize healthcare resource utilization.

Key Responsibilities

Apply evidence-based medicine, clinical guidelines, and policy terms during preauthorization reviews.
Ensure appropriate utilization of healthcare services and prevent unnecessary costs.
Support cost-containment initiatives through effective medical adjudication and utilization management.
Ensure clinically sound and consistent medical decisions, monitoring decision quality and adherence to medical protocols.
Promote provider satisfaction through effective communication and partnership management.
Manage and escalate high-value, complex, or critical cases as 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 and 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.

Qualifications and Experience

Candidates for this role should possess 3 years of relevant experience. The position requires a professional who can ensure clinically appropriate decisions while managing medical costs and maintaining compliance.