Medical Advisor

6 days ago

Riyadh, Saudi Arabia Intelligent Solutions HR Consultancy Full time

**General Overview**:
Our client, a large Multinational Insurance Company are looking to hire a Medical Advisor to join their team in Riyadh, KSA.

**Responsibilities and Duties**:

- Part of a clinical team that provides medical management services to customers in KSA.
- Handles most complex cases with full autonomy for decision-making while identifying and resolving barriers that hinder effective patient care. Recognized internally as “the go-to person” for the most complex Health Services assignments and as a “Subject Matter Expert”.
- Provides strategic planning, and direction of a quality, cost-effective delivery system providing health services to members.
- Studies trends and develops processes and procedures to ensure quality service.
- Establishes process and procedures to ensure quality programs will meet or exceed guidelines or requirements by specific assigned vendors. Responsibilities include, but are not limited to: analysing and appraising management as to performance of vendor services using measurement criteria; collecting and analysing data, identifying variance and unacceptable performance, and monitoring correction and ongoing compliance; providing resources and expertise in the areas of regulatory mandates, accreditation standards, and implementing quality management process policies and procedures; and managing individual case review and investigation.
- Serves as a resource/educator regarding specific areas of expertise.
- Uses deep professional knowledge and acumen to advise functional leaders on development of wellness programs for internal and external stakeholders.
- Serves as clinical advisor to the sales, client management, broker management and underwriters, by providing ongoing product and industry knowledge/education that positively influence cost, quality, and customer satisfaction.
- Maintains updated knowledge of local and regional regulatory insurance mandates and clinical policies, and responsible for relaying this information to the team and relevant stakeholders.
- Assist in payment integrity by detection of fraud, waste, or abuse in medical review process, with clinical advice where required.
- Manages inpatient and outpatient medical costs at levels consistent with the plan's objectives by directing the case management, medical review, utilization review, quality assurance/improvement, and/or health education programs.
- Focuses on implementing and executing strategies within own team.
- Manages the development of processes and procedures to ensure the quality of the medical review process and responsible for the performance, productivity, and quality of the clinical team.
- Other duties as assigned.

**Requirements**:
**Minimum Requirements**:

- Medical Doctor Degree with international healthcare experience specially in KSA and Middle East region.
- 5+ years of clinical experience preferable in a payer setting on medical management.
- 2-3 years of managerial and leadership experience.
- Experience in utilization/case management, cost containment services, managed care, insurance coverage, and financial management.
- Strong interpersonal and communication skills.
- Demonstrates pro-active problem-solving and analytical skills.
- Ability to operate a personal computer, proficient with Microsoft office products and a variety of software for medical management.
- Ability to build solid working relationships with staff, matrix partners, clients, customers, and healthcare providers.
- Stress resistant and efficient, finding a good balance between quality and quantity.

**Language Requirements**:

- English: Read, write and speak fluently.
- Arabic is a plus.

Work Experience

5+ years

Industry

Insurance

City

Riyadh

Province

Riyadh

Country

Saudi Arabia

Postal Code

11564

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