Home Saudi Arabia Care Managment Officer 1
Home Saudi Arabia Care Managment Officer 1
Care Managment Officer 1
Job details
The jobholder is responsible for performing care management activities with minimal supervision including monitoring, inspection, and enablement of medical providers to ensure compliance with guidelines and standards. Job Responsibilities:
- Execute all activities, approaches and tools under minimal supervision
- Coordinate and communicate proactively with internal stakeholders
- Collect data and perform data entry
- Update on a continuous basis the database for tracking and reporting
- Escalate complex problems to ensure case/issue is closed efficiently and in a timely manner
- Assist team members and provide input to ensure projects and tasks are completed on time
- Monitor financial obligations of medical providers and detect and investigate accordingly
- Monitor any misuse of resources or fraud conducted by medical providers in coordination with Data and Artificial Intelligence and investigate accordingly
- Monitor waste in terms of the number of surgeries and medical tests that are not needed per beneficiary and investigate accordingly
- Conduct regular onsite monitoring of medical providers in line with inspection plan and schedule to ensure adherence to standards and guidelines
- Develop inspection reports and communicate findings with medical providers
- Follow-up with non-compliant medical providers to implement corrective or enforcement actions based on decision taken
- Update inspection dashboards to inform internal stakeholders of results, updates, and corrective actions
- Conduct training sessions to ensure alignment with the standards and guidelines
- Receive medical providers queries and clarifications and escalate to concerned stakeholders for advice and support
- Respond to inquiries related to the drug formulary
- Bachelor's degree in medicine, pharmacy, Hospital Management or a related field
- Certificate in insurance or Certified Insurance Examiner (CIE) or Certified Medical Insurance Specialist (CMIS) or Certified Health Insurance Specialist (CHIS) or any other equivalent certification is preferable
- Proficient in oral and written English language (Intermediate)
- 3+ years of relevant experience
- Experience in monitoring, inspection, enablement
- Previous experience in insurance sector or healthcare sector is a must
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Hiring company
Council Of Health Insurance
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