Pre-Authorization Medical Quality Manager

Bupa Arabia; Al Khobar; On-site; SAR 150,000 - 200,000; Full time

Job summary

A leading healthcare organization in Saudi Arabia is seeking a qualified medical professional to manage medical decisions and ensure compliance with regulations. The ideal candidate will have a valid Saudi Commission, clinical experience in general practice or emergency medicine, and a commitment to high-quality patient care. This position requires at least 3 years of clinical experience and offers opportunities to contribute to team capability building.

Qualifications

• Minimum 3 years of clinical experience excluding internship year.

Responsibilities

• Ensure medical spend is controlled by ensuring pre-authorization decisions are within defined regulations.
• Adjudicate the cases based on common medical practice in line with protocols.
• Ensure decisions are according to best medical standards to prevent abuse and overtreatment.
• Achieve daily productivity targets and ensure proper interpretation of clinical skills.
• Report all high value claims and highlight any fraud or abuse.

Skills

Valid Saudi Commission

Clinical experience in General practitioner

Clinical experience in Emergency Medicine

Clinical experience in Family Medicine

Insurance experience

Education

Medicine and Surge

Job description

A leading healthcare organization in Saudi Arabia is seeking a qualified medical professional to manage medical decisions and ensure compliance with regulations. The ideal candidate will have a valid Saudi Commission, clinical experience in general practice or emergency medicine, and a commitment to high-quality patient care. This position requires at least 3 years of clinical experience and offers opportunities to contribute to team capability building.