Title: Medical Approval Doctor
- 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…)
- Insure that all needed required documentation (referral form, completed medical reports, related investigation results) are in order.
- Review all referred cases to determine completeness of documentation, accuracy of the differential diagnosis and take most appropriate and timely recommendation and action
- Participate in committees, work groups, and/or process improvement teams that improve patient satisfaction.
- Review all medical approvals & claims.
- Issuance of necessary medicines and medical approvals – surgeries – X-rays – tests that require it
- Medical solving customer problems.
- For all non-urgent cases review the need for referral and admission if requested
- 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 and ask for daily progress note from treating doctor and make the necessary extended length of stay if needed, till 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
- Guide and supervise the referral officer on priority setting, management of resources including the ambulances
- Provide on job training to medical and referral staff
- Supervise reporting of IMC referral activities/statistics, analysis
- Support medical team in day-to-day activities, in areas of specialty such as chronic patients, ER
|Job Location:||Amman, Jordan|
|Job Role:||Medical, Healthcare, and Nursing|
|Company Industry:||Non-profit Organization|
|Career Level:||Mid Career|