Manager - Medical Pre Authorisation

Job Description Ensure clinically appropriate, evidence-based preauthorization decisions through effective utilization management, regulatory compliance, and provider engagement, while safeguarding patient outcomes, enhancing customer experience, and optimizing healthcare resource utilization. Medical Cost & Service Management • Apply evidence-based medicine, clinical guidelines, and policy terms during preauthorization review. • Ensure appropriate utilization of healthcare services while preventing unnecessary costs. • Support cost-containment initiatives through effective medical adjudication and utilization management. Quality Medical Decision & Patient Safety • Ensure clinically sound and consistent medical decisions. • Monitor decision quality and adherence to medical protocols. • Promote provider satisfaction through effective communication and partnership management. Business Support & Stakeholder Management • Manage and escalate high-value, complex, or critical cases when required. • Participate in complaint resolution and support business continuity efforts. • Maintain effective communication with internal and external stakeholders. • Report operational risks and critical incidents in a timely manner. Compliance, Governance & Risk Management • Ensure adherence to Bupa policies, medical protocols, and regulatory requirements. • Comply with CHI regulations and governance standards. • Identify, escalate, and report suspected fraud, waste, abuse, and anti-selection activities. • Support audit readiness and compliance monitoring activities. Skills Minimum 3 years of Experience – Medical Clinical experience as General Practitioner / Emergancy / Family Medicine Medical insurance practice Language (English) and basic computer skills Bachelor’s in medicine or equivalent Postgraduate in Medicine Show more Show less

Ensure clinically appropriate, evidence-based preauthorization decisions through effective utilization management, regulatory compliance, and provider engagement, while safeguarding patient outcomes, enhancing customer experience, and optimizing healthcare resource utilization. Medical Cost & Service Management: Apply evidence-based medicine, clinical guidelines, and policy terms during preauthorization review. Ensure appropriate utilization of healthcare services while preventing unnecessary costs. Support cost-containment initiatives through effective medical adjudication and utilization management. Quality Medical Decision & Patient Safety: Ensure clinically sound and consistent medical decisions. Monitor decision quality and adherence to medical protocols. Promote provider satisfaction through effective communication and partnership management. Business Support & Stakeholder Management: Manage and escalate high-value, complex, or critical cases when required. Participate in complaint resolution and support business continuity efforts. Maintain effective communication with internal and external stakeholders. Report operational risks and critical incidents in a timely manner. Compliance, Governance & Risk Management: Ensure adherence to Bupa policies, medical protocols, and regulatory requirements. Comply with CHI regulations and governance standards. Identify, escalate, and report suspected fraud, waste, abuse, and anti-selection activities. Support audit readiness and compliance monitoring activities.