Manager Medical Pre Authorisation

About the Role

Bupa Arabia is seeking a Manager Medical Pre Authorisation to join their team in Riyadh, Saudi Arabia. This full-time role involves ensuring clinically appropriate and evidence-based preauthorization decisions, focusing on effective utilization management, regulatory compliance, and provider engagement. The position aims 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 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.
• Ensure adherence to Bupa policies, medical protocols, and regulatory requirements, including 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 5-10 years of relevant experience. The position requires a professional who can ensure regulatory compliance and effective provider engagement while maintaining high standards of patient care and customer satisfaction.

Work Environment

This is a full-time position based in Riyadh, Riyadh, Saudi Arabia. The role operates within a framework that emphasizes adherence to Bupa policies, medical protocols, and regulatory requirements.

Application Process

The salary for this position will be disclosed during the application process. Qualified candidates are encouraged to apply.