فرصة عمل إدارية طبية لدى سوليدرتي للتامين
Medical Approval Officer
Job Summary:
The Medical Approval Officer at Solidarity First Insurance Company is responsible for reviewing and approving medical requests and treatments for patients in field operations. This includes evaluating patients' records, consulting their medical professionals, and making decisions on the appropriate course of care. The Medical Approval Officer also plays a key role in ensuring the quality of care provided in the field and may be involved in developing and implementing medical protocols and guidelines.
Main Tasks and Responsibilities:
Medical Approval Officer is a roaster-based job within a team, in which they are responsible for:
- Answer inbound calls as well as assist parties who have specific inquiries.
- Queries may range between coverage questions, network location and medical questions.
- Receive, evaluate, and assess approval requests from Healthcare providers (Hospitals, Laboratories, pharmacies…).
- Ensure that all needed required documentation (referral form, completed medical reports, related investigation results) is in order.
- Review all referred cases to determine the completeness of documentation, and accuracy of the differential diagnosis and take the most appropriate and timely recommendation and action.
- Participate in committees, work groups, and/or process improvement teams that improve patient satisfaction.
- Issuance of necessary medicines and medical approvals - surgeries - X-rays - tests that require it.
- Be the lead and responsible key person to communicate and negotiate with the external hospital, medical facility or treating doctor.
- Allocate the necessary approvals for outpatient services including but not limited to radiology, lab tests, day-case diagnostic or therapeutic procedures and chronic medications.
- Ensure follow-up of referred cases in the outside facility as well as on medication, appointment and further required follow-up.
- Daily follow-up for all admitted and inpatient cases, ask for daily progress notes from the treating doctor and extend stay if needed until the patient is discharged.
- Follow up on the feedback of referred cases and ensure that the feedback is communicated properly with the patient or attending physician as appropriate.
Other preferable skills are:
Excellent verbal communication skills.
Excellent listening skills.
Must be computer literate.
Excellent command of the English language.
Decision-maker and high problem-solving skills.
Minimum Requirements:
Bachelor's Degree in Medicine or Nursing.
MOH License of practice medicine from Jordan.
At least 1 - 3 years of experience.
Interested candidates are invited to send their CVs , & please mention “Medical Approval Officer “ in the email subject.
