Manager Medical Pre Authorisation

About Bupa Arabia and the Role

Bupa Arabia is seeking a Manager Medical Pre Authorisation to join its team in Jeddah, Makkah, Saudi Arabia. This full-time position is central to ensuring clinically appropriate and evidence-based preauthorization decisions within the healthcare sector.

Role Purpose

The primary purpose of this role is to oversee and ensure clinically appropriate, evidence-based preauthorization decisions. This involves effective utilization management, adherence to regulatory compliance, and proactive provider engagement, all while safeguarding patient outcomes, enhancing the customer experience, and optimizing 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 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.

Qualifications and Experience

• Clinical experience as a General Practitioner, Emergency Physician, or Family Medicine Physician.
• A minimum of 3 years of relevant professional experience.

Application Information

Candidates meeting the above criteria are encouraged to apply.