About the job

métier - Strategic HR Solutions is hiring a 𝐌𝐞𝐝𝐢𝐜𝐚𝐥 𝐀𝐩𝐩𝐫𝐨𝐯𝐚𝐥 𝐌𝐚𝐧𝐚𝐠𝐞𝐫 – 𝐎𝐏 & 𝐈𝐏 for one of our leading clients in the UAE.

We are looking for an experienced medical professional to oversee OP/IP pre-authorizations, clinical reviews, and medical approvals while ensuring timely decisions and compliance with medical and policy guidelines.

• 𝐊𝐞𝐲 𝐑𝐞𝐬𝐩𝐨𝐧𝐬𝐢𝐛𝐢𝐥𝐢𝐭𝐢𝐞𝐬:Review and process OP/IP pre-authorization requests within agreed TAT.
• Assess medical necessity, diagnosis, 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/Case Management team.
• Ensure accurate documentation and compliance with regulatory and internal requirements.

• 𝐐𝐮𝐚𝐥𝐢𝐟𝐢𝐜𝐚𝐭𝐢𝐨𝐧𝐬 & 𝐄𝐱𝐩𝐞𝐫𝐢𝐞𝐧𝐜𝐞:MBBS, BDS, Nursing, Allied Health, or relevant healthcare qualification preferred.
• 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.
• Good knowledge of medical necessity, treatment protocols, policy benefits, exclusions, and UAE healthcare regulations.
• Additional qualifications in Medical Coding, Health Insurance, Claims Management, or Clinical Audit are an advantage.
• Valid UAE health-professional license, where applicable, is preferred.
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