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Medical Approval Manager

Smart Medical Services
Dokki, Giza
Posted 5 years ago
166Applicants for1 open position
  • 145Viewed
  • 0In Consideration
  • 0Not Selected
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Job Details

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Job Description

Main functions and responsibilities:

  • Plan and direct the operation of Medical Approval Team in accordance with the department objectives.
  • Prepare department’s yearly budget, plans and suggest recommendations.
  • Analyze prior-approval requests, negotiate the cases with the providers when necessary and approve payment against Pre-approvals on medical cases
  • Ensure that medical cases and customers queries are solved in accordance with Company quality standards in order to reach customer medical necessity and satisfaction.
  • Consult the Global Clinical Team Experts for complicated medical cases.
  • Cascade Company objectives to the team leaders, ensure proper communication on new projects and new services; facilitate the workflow between the Medical Approval Department and all other departments.
  • Review and analyze Medical service activities and data in order to support planning and risk management and to improve service utilization.
  • Prepare monthly statistical reports to VP Medical related to department operation, budget and cost containment, customer and provider complaints and medical cases.
  • Report regularly the team’s performance to VP Medical.
  • Appoint Team Leaders, assign responsibilities, set objectives and assess their performance to measure achievements against these objectives.
  • Coach, develop and guide the Team Leaders.
  • Ensure that Company core competencies, values, and policies are implemented across the Department teams.
  • Support the Team Leaders in the process re-engineering and update.
  • Miscellaneous tasks within the scope of work, as assigned by the direct manager.

Job Requirements

  • Doctor degree is mandatory
  • Business Management Certificate or equivalent is a plus
  • 8 years’ experience; preferably in the health insurance field
  • Microsoft Office: proficiency in Excel & word
  • Analytical thinking
  • Costumer focus
  • Quality orientation
  • Problem-solving
  • Managerial skills
  • Leadership skills
  • Organizational skills
  • Communication Skills

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