Sr. Officer - Medical Pre - Authorization ( Pharmacist / Nurse )
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الوصف الوظيفي The role responsible for the following: - Medial cost & Service Management: - Ensure the decisions are according to the best medical standards and agreements’ terms & conditions in order to prevent abuse, fraud and overtreatment - Ensure member safety through working with High Quality of decision making with Zero QDI (Quality Demerit Index) A or B - Ensure the medical decisions are consistent and proper implementation of the clinical and practice guidelines signed off by the organization - Ensure achieving of daily targets in terms of productivity & speed of response - Ensure proper interpretation and usage of clinical skills - Ensure compliance to policy and Regulation • Report all high Value claims as per agreed process with in Out Patient services - Highlight and report fraud, abuse, and anti-selection Apply terms and conditions of Bupa declaration policy in SMEs products Following CCHI policy terms and conditions - Support & contribute in capability building, constantly upgrade his knowledge and experience in order to meet challenges المهارات - Bachelor’s degree in any relevant majors pharmaceutical, Nursing majors. - Fresh graduate up to 3 years experience. - Ability to conduct business in English language. - Ability to work under pressure. - Strong communication skills. تفاصيل الوظيفة https://www.bayt.com/ar/saudi-arabia/jobs/sr-officer-medical-pre-authorization-pharmacist-nurse-4208523/ |
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