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Medical Manager -KSA

MedNet Global Healthcare Solutions LLC

Posted on September 5, 2019

2 - 3 years Jeddah - Saudi Arabia

Any Graduation. Any Nationality

Opening 01

Job Description

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For
MedNet KSA
MedNet KSA
is one of the leading managed care service organizations that caters to
healthcare needs and offers financial protection against unforeseen health
risks. We are currently seeking to hire a Medical Manager with the following
tasks and responsibilities:
Your Job:
• Manage the effective achievement of the medical
department objectives through setting individual objectives, managing
performance, developing staff and providing formal and informal feedback in
order to maximise overall performance and team motivation.
• Prepare and recommend the department budget and
monitor financial performance versus the budget so that the business is aware
of anticipated costs/ revenues, and areas of unsatisfactory performance are
identified, rectified promptly and potential performance improvement
opportunities are capitalised upon
• Plan and manage the overall operations of the
medical department in order to ensure achievement of optimum customer
satisfaction with the medical review services in accordance with established
quality parameters and Munich Health policies and procedures
• Lead and manage the effective evaluation of
in-hospital cases in respect of medical necessity and appropriateness and
provide approval of benefits as per the policy wordings and based on medical
point of view.
• Lead and manage the effective evaluation of
outpatient claims authorization in respect to the medical necessity and
appropriateness and check them in the system to ensure adherence to policy
guidelines.
• Ensure effective communication with insurance
companies concerning the policy coverage issues and ensure prompt provision of
solutions in accord with established corporate policies and guidelines.
• Ensure functional relationship between internal
departments to work well via claims evaluation and authorisation and high level
of communication and efficient & timely transfer of information takes place
during operations.
• Recommend
improvements to departmental policy and manage the implementation of procedures
and controls covering all areas of claims review, evaluation and approval activity
so that all relevant procedural requirements are fulfilled while delivering a
quality, cost-effective service
Your Profile:
• Medical degree from a school recognised by the
World Health Organisation (WHO)
• 6 years in a similar environment in the TPA /
medical insurance sector as well as 2 years of managerial experience,
preferably in the Gulf region.
• Knowledge of all local market related health
system
• Knowledge of local insurance laws &
regulations.
• Understanding of the insurance principles,
business models
• Structured, analytical and results oriented
approach
• Attention to detail
• Ability to operate effectively with people at
all levels of the business.


Insurance

Keywords

Medical Manager -KSA

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MedNet Global Healthcare Solutions LLC


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