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Job Description
- Plan and direct the operation of Medical Team in accordance with the department objectives.
- Prepare department’s annual 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 queries are solved in accordance with Company quality standards in order to reach medical necessity and satisfaction.
- Consult physicians and medical experts for complicated medical cases.
- Prepare monthly statistical reports related to department operation, budget and cost, employees complaints and medical cases.
- Manage routine daily claims administration work.
Job Requirements
- A bachelor’s degree in Pharmacy or Medicine is required.
- 10 - 15 years of experience in healthcare industry is required.
- Experience in hospital management and/or medical claims is preferred.
- Superior judgment, negotiation, and decision-making skills.
- Strong managerial competencies in the areas of leadership and team development, managerial coaching, and mentoring and situational assessment skills and with a proven track record in building and developing high performing teams.
- Excellent organizational skills
- An effective communicator at all levels in the organization, with strong oral, written and persuasive skills.
- Strong ethics and a high level of personal and professional integrity.
