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Medical Approval Manager
métier - Strategic HR Solutions
Dubai, UAE
Full-time
Mid-Senior
Onsite
Discovered 1 weeks ago
Medical pre-authorizationsOP/IP medical approvalsClinical reviewMedical necessity assessmentMedical insuranceClaims management
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Medical pre-authorizationsOP/IP medical approvalsClinical review
Role Overview
The employer is hiring a Medical Approval Manager for outpatient and inpatient medical approvals for a client in the UAE.
The role oversees pre-authorizations, clinical reviews, and medical approval decisions while ensuring timely outcomes and compliance with medical and policy guidelines.
Key Skills for This Role
Medical pre-authorizationsOP/IP medical approvalsClinical reviewMedical necessity assessmentMedical insuranceClaims management
Full Job Posting
Role Overview
The employer is hiring a Medical Approval Manager for outpatient and inpatient medical approvals for a client in the UAE.
The role oversees pre-authorizations, clinical reviews, and medical approval decisions while ensuring timely outcomes and compliance with medical and policy guidelines.
Key Responsibilities
- Review and process outpatient and inpatient pre-authorization requests within agreed turnaround times.
- Assess medical necessity, diagnoses, treatment plans, and supporting clinical documentation.
- Approve, pend, or reject requests based on policy terms, clinical guidelines, and medical necessity.
- Coordinate with hospitals, doctors, insurers, and internal claims teams.
- Identify and escalate high-cost or complex cases to the Medical Director or Case Management team.
- Ensure accurate documentation and compliance with regulatory and internal requirements.
Qualifications and Experience
- MBBS, BDS, Nursing, Allied Health, or another relevant healthcare qualification is preferred.
- At least 5 years of experience in medical insurance, hospital insurance desks, utilization review, or claims management.
- Hands-on experience in OP/IP medical approvals, pre-authorizations, and clinical review.
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