الوصف الوظيفي

Medical Pre-Authorisation Manager

We are seeking a dynamic and clinically astute Manager to oversee the medical pre-authorisation process, ensuring accurate and timely decisions that balance member health with cost-effectiveness. The ideal candidate will possess a strong clinical background and a proven ability to manage case volumes while maintaining high standards of patient safety and service quality.

Key Responsibilities:

Adjudicate inpatient and outpatient pre-authorization cases, aligning with common medical practices, Bupa protocols, and policy.
Apply client agreement terms and conditions to each case.
Make consistent, clinically sound decisions, adhering to approved clinical and practice guidelines, and prioritizing member health and safety.
Ensure prompt case adjudication to maintain a responsive service to hospitals and members.
Manage case volumes to sustain productivity and turnaround.
Process authorizations in line with company policy and applicable regulations, escalating high-value transactions as required.
Identify and report suspected fraud, abuse, and anti-selection through the appropriate channels.
Contribute to medical and operational projects that enhance the pre-authorisation function.

Qualifications: