We are seeking a highly skilled and experienced Manager for our Medical Pre-Authorization department. The ideal candidate will oversee the pre-authorization process, ensuring compliance with medical policies, guidelines, and regulations. They will be responsible for managing a team, streamlining operations, and improving the efficiency and accuracy of the pre-authorization process.

Job Location: Saudi arabia

Key Responsibilities:

To ensure medical spend (In-Patient & Out-Patient services) is controlled by ensuring that pre-authorization decisions are within defined SAMA & CCHI regulations, accepted guidelines and high quality medical standards, safeguarding the member's health & safety and aligned to BUPA Values.

Medial Cost & Service Management

Adjudicate the cases (In-Patient & Out-Patient) based on common medical practice and inline with Bupa protocols and policy .

Ensure the decisions are according to the best medical standards and agreement terms & conditions in order to prevent abuse, fraud and overtreatment

High quality medical decision & patient safety

Ensure working with high quality of decision making with Zero QDI (Quality Demerit Index) A or B

Ensure the medical decisions are consistent and are implemented based on clinical and practice guidelines signed off by the organization