ROLE PURPOSE
Managing a group of hospitals to ensure that inpatient customers are receiving optimal healthcare within agreed quality parameters along with securing the organization from fraud and abuse.
KEY ACCOUNTABILITIES
1. Interacting, coordinating, and dealing with Consultants, Medical Directors Insurance offices and Provider Management
• Agree case mgmt plans with Consultants.
• Close followup of all in-patient cases daily.
• Raise issues with Provider Medical mgmt as needed.
• Ensure that all approvals and rejections are as agreed.
• Make sure invoicing is as agreed.
2. Ensuring the member safety and protecting the organization from fraud and abuse
• Ensure high quality of the medical decisions (to be in line with the adopted clinical/practice guidelines).
• Secure the organization from medical and legal liabilities.
• Ensure medical cost control & cost effectiveness.
• Secure the organization from fraud & abuse.
• Highlight inappropriate utilization trends by the providers.
• Ensure adherence to policy and CCHI regulations.
• Effective interaction with the concerned departments for achieving all the above.
3. Interacting and dealing with the members and their relatives
• Proactively contacting with inpatients and their relatives to promote Bupa image and solve any problems the customer - or his family - may have with the hospital.
• Coordinating with the sales, customer services, and membership if necessary to solve members' problems.
• Active interaction with healthcare operations team for sorting out the customers' needs and queries.
• Actively and effeciently participate in sorting out customers & CCHI complaints.
4. Proper and informative reporting
• Submitting a daily sheet with accurate, detailed input on all inpt cases and reasons for decisions for the day.
• Regularly reporting savings to the regional manager.
• Reporting High Value Claims to Provider Relations.
• Regularly reporting fraud to the regional manager.
5. Business intellegence
• Proactively searching for, and reporting to the regional manager, all competitors and providers practices.
• Actively participating in all the benchmarking activities needed by the organization.
6. Building a better BUPA
• Enhance and upgrade personal skills and knowledge, and improve & build own capabilities.
• Participate actively in internal and external activities, initiatives & responsilbilies.
• Fuction as a surveying and / or branding tool whenever needed.
7. Supporting Clinical Excellence program
• Regularly submitting the Clinical Excellence sheet to the clinical excellence manager.
تفاصيل الوظيفة
| 2013-10-27 | تاريخ الإعلان عنها: |
| الرياض, المملكة العربية السعودية | منطقة الوظيفة: |
| الطب | الدور الوظيفي: |
| صحة عامة/غير ذلك; تأمين | قطاع الشركة: |
| 2013-11-10 | تاريخ الالتحاق بالعمل: |
المرشح المفضل
| متوسط الخبرة | المستوى المهني: |
| بكالوريوس/ دبلوم عالي | الشهادة: |
تقدم الآن - وظائف في السعودية - وظائف في جدة, المملكة العربية السعودية - وظائف في الرياض, المملكة العربية السعودية - وظائف الطب في السعودية - بحث عن جميع الوظائف
http://www.bayt.com/ar/job/hospital%2daudit%2ddoctor%2din%2dsaudi%2darabia%2d2975472/
