Manager Medical Pre Authorisation

📣 إعلان

منذ 20 يوم

	نوع العقد	دوام كامل
	طبيعة الوظيفة	بالموقع
	الموقع	جدة

وصف الوظيفة

About the Role

Bupa Arabia is seeking a Manager - Medical Pre Authorisation to lead preauthorization decisions. This full-time role is based in Jeddah and focuses on ensuring clinically appropriate and evidence-based healthcare approvals.

Role Purpose and Impact

The primary purpose of this role is to ensure clinically sound and evidence-based preauthorization decisions. This involves effective utilization management, adherence to regulatory compliance, and active provider engagement to safeguard patient outcomes, enhance customer experience, 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 while preventing unnecessary costs.
Support cost-containment initiatives through effective medical adjudication and utilization management.
Ensure clinically sound and consistent medical decisions.
Monitor 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 Governance

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.

Experience Requirements

Candidates for this position are required to have 3-5 years of relevant experience in medical pre-authorization or a related healthcare management field.