Overview
Medical Excellence Manager Jobs in Dubai, United Arab Emirates at MedNet Global Healthcare Solutions LLC
Title: Medical Excellence Manager
Company: MedNet Global Healthcare Solutions LLC
Location: Dubai, United Arab Emirates
As a member of Munich Re the MedNet Group is a leading Third-Party Administrator across the MEA region. The Medical Excellence Manager is responsible for ensuring the highest standards of medical excellence across various functions within the organization. This role requires a strategic thinker with a solid background in healthcare management, quality assurance, and process optimization. The successful candidate will drive initiatives that enhance operational efficiency, improve clinical outcomes, and safeguard against fraud waste and abuse.
Your Role:
Develop and implement MedNet’s Medical Excellence strategy. Identify and prioritize transformation initiatives, lead their implementation within the agreed budget and timeline.
Ensure operational discipline across all functions within the department i.e. effective steering and monitoring of day to day activities, tracking and delivery of assigned KPIs, up to date standard operating procedures, etc
Develop and implement effective automation enhancements on claims and pre-approval processes, involving the medical rules engine, enhancing operational workflows and decision-making processes.
Coordinate and oversee the reconciliation processes to ensure accurate and timely financial reporting, inc lose collaboration with medical network providers, to ultimately reduce the impact of commercial closures
Oversee and manage quality assurance initiatives related to claims and pre-approvals, ensuring compliance with regulatory standards and internal policies.
Analyze data and performance metrics to identify opportunities for improvement and implement corrective actions as needed.
Effectively manage a team of highly skilled individuals, foster a culture of continuous improvement through training and development initiatives for staff across various functions.
Prepare and present reports on quality metrics, fraud detection efforts, and automation outcomes to senior management and stakeholders.
Act as a role model for the team and proactively collaborate/share best practices with colleagues. Deputize the Operations Manager as needed and undertake any additional task as required by the hierarchy.
Your profile:
Bachelor’s degree in Healthcare Management, Nursing, Business Administration, or a related field.
Minimum of 7 years of experience in healthcare management, quality assurance, or related roles, with a focus on health insurance or TPA operations.
Strong understanding of medical coding, billing practices, and regulatory compliance in the healthcare sector. Relevant certifications (e.g., CFE, coding & billing, etc) are appreciated.
Proven experience in project management, process improvement and automation, particularly with medical rules engines.
Excellent analytical skills with the ability to interpret complex data and drive strategic decision-making.
Munich Re not only stands for fairness with regard to its clients; it is also an equal opportunities employer.
