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Job Description
The Sr. Manager - Medical Care Operations will be managing a team of doctors to ensure the quality of medical services given to our patients through case management, communication with patients, physicians and providers to ensure the best care along with reporting and profiling the provision of care. Development of centers of excellence using the data available and through collaboration with other stakeholders internally and externally
Job Responsibilities:
Case management of inappropriately cared for cases
- Define criteria for flagging of cases within the different business functions
- Develop an operational mechanism to handle cases with the medical back office managers
- Assist in managing the live cases with the medical back office managers
- Develop a reporting mechanism to the medical director on reported cases
Healthcare outcomes measurement
- Develop a mechanism of reporting cases both internally and externally after collaboration with the different stakeholders
- Collate data from different functions internally and externally to assist in profiling the providers
Providers, services and physicians profiling
- Benchmark the providers, services and physicians according to the healthcare outcomes measured
- Define the best practices across the provider’s network based on the clinical data available to assist Provider Relations to direct their efforts in contracting with certain services
Building relationships and communication with providers
- Developing and maintain strategic relations with key administrative and clinical staff inside the providers to support the partnership concept
Centers of excellence
- Identify areas that are required to focus on to develop centers of excellence based on clinical and commercial needs
- Assess the different providers at different networks at all regions for suitability to be a center of excellence
- Collaborate with Providers Relation to aid the negotiation with the providers from the clinical point of view
- Develop an assessment and auditing tool to ensure the continuation of excellence of care
Medical Decision making
- Play an active role in the Clinical Governance Committee
- Play an active role in solving medical/insurance cases
- Be available for all Bupa business projects that require senior medical input and/or judgements
Resolution of disputes of all cases raised within the business
- Develop a mechanism to pool all disputed cases within Bupa Arabia
- Develop an operational mechanism to handle such cases with the managers
- Develop a reporting mechanism to the medical director on the disputed cases
Skills
Education
- Bachelors in Medicine
- Diploma or Masters in a Medical discipline
Years of Experience
- At least seven years of active medical experience
- At least five years in HealthCare Management
