Medical Care Pre-Authorization Specialist

MedNet Global Healthcare Solutions LLC; Muscat; On-site; OMR 9,000 - 13,000; Full time

Job summary

Oman MedNet Group in Oman is seeking an Officer - Medical Care Unit to review outpatient and inpatient pre-authorization requests, assess medical necessity, and ensure proper documentation and system updates. The role requires rigorous medical policy application and timely processing within a managed care framework.

Applicants should have a Bachelor's in Nursing or Pharmacy with 2-3 years of UAE managed care experience, strong English communication, and MS Office proficiency.

Qualifications

• Bachelor's degree in Nursing or Pharmacy, preferred.
• Minimum 2-3 years of experience in the UAE managed care industry.
• Good knowledge of health insurance concepts and the UAE healthcare system.
• Proficient in MS Office, including Excel and PowerPoint.
• Good command of written English.

Responsibilities

• Review and process outpatient and inpatient pre-authorization requests in line with medical policies and benefits.
• Assess medical necessity based on clinical information, medical guidelines, and policy terms.
• Ensure accurate medical coding, approvals, documentation, and system updates.
• Process pharmacy authorization requests within required turnaround times.
• Provide clear rationale for decisions while maintaining accuracy, quality, and medical ethics.
• Identify and elevate suspected fraud or abuse and unusual medical trends.
• Handle provider queries, second opinions, and case management efficiently.
• Manage changing workloads and shift-based duties while meeting quality and productivity targets.

Skills

Interpersonal skills

Negotiation skills

Analytical thinking

Problem solving

Organizational skills

Written English

Education

Bachelor's degree in Nursing or Pharmacy

Tools

MS Office

Job description

Oman MedNet Group in Oman is seeking an Officer - Medical Care Unit to review outpatient and inpatient pre-authorization requests, assess medical necessity, and ensure proper documentation and system updates. The role requires rigorous medical policy application and timely processing within a managed care framework.

Applicants should have a Bachelor's in Nursing or Pharmacy with 2-3 years of UAE managed care experience, strong English communication, and MS Office proficiency.