Summary
Bupa Arabia is seeking a Medical Pre-Authorization Manager in Riyadh. The role oversees evidence-based preauthorization decisions, utilization management, medical cost control, decision quality, patient safety, and compliance with company policies and CHI regulations. The manager also handles complex cases, supports complaint resolution and audit readiness, and works with internal and external stakeholders. Applicants should have at least 3 years of medical experience, clinical experience in general practice, emergency medicine, or family medicine, a bachelor’s degree in medicine or equivalent, postgraduate medicine qualifications, English, and basic computer skills.
The posting
As published on bupa.com.sa. Pulled from the employer's site and shown as they wrote it.
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