MedNet Egypt is one of the leading managed care service organizations that caters to healthcare needs. We are currently seeking to hire a Medical Manager to manage the overall operations of the medical excellence department in order to ensure achievement of optimum customer satisfaction with the medical review services 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.
- Lead and manage the effective evaluation of in-hospital cases and outpatient claims in respect of medical necessity and appropriateness
- Provide overall guidance and leadership to the medical team in terms of authorization activities, claims review, evaluation and as well as ensuring compliance with established policy guidelines
- Manage and maintain standardized procedures for pre-authorization, utilization review, case management, discharge planning and related medical management tools in accordance with corporate policies and guidelines
- Approve medical authorization requests (as per delegated authority) if they comply with all stipulations and lead the medical auditing process and signing of all inpatients claims.
- Ensure effective communication with payers concerning scope of coverage issues and ensure prompt provision of solutions in accord with established corporate policies and guidelines
- 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 capitalized upon.
- Manage payers and providers reconciliation to ensure timely closure and deductions settlement.
- Manage Fraud, Waste and Abuse function and ensure prevention, early detection and reporting of any fraudulent trends.
- Maintenance of system rules to ensure optimized automation and leakage control.
Your Profile
- Bachelor's degree in medicine or pharmacy.
- Minimum 6 years of experience in TPA / medical insurance sector, 3 of which to be in a supervisory role.
- Very good command of English language.
- Very good command of excel.
- Good interpersonal and negotiation skills.
- Excellent written and verbal communication skills.
- Strong leadership, planning and organizational skills.
- Ability to handle stress.
- Decision Maker.
