Approval Services Manager

CARE Medical
Riyadh
Workplace: OnsiteFull timeFunction: Solutions Engineering & Sales EngineeringSkills: ["Decision making","Strategic thinking","Leadership","Team development","Stakeholder communication"]

Lead the medical pre-authorization and approval function for healthcare service requests. You will set department goals, guide direct reports, and oversee review decisions for clinical appropriateness and regulatory compliance. Serve as a liaison between medical providers, internal departments, and regulatory bodies to support timely patient care approvals. Own quality assurance for approval decisions, resolve escalated cases and appeals, and report approval trends, turnaround times, and denial reasons.

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FursaFursa
CARE Medical
CARE Medical
1 month ago

Approval Services Manager

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Source: Company careers pageValidated by: Fursa AI
Last checked: 20 hours agoStatus: Live

Job Summary

Lead the medical pre-authorization and approval function for healthcare service requests. You will set department goals, guide direct reports, and oversee review decisions for clinical appropriateness and regulatory compliance. Serve as a liaison between medical providers, internal departments, and regulatory bodies to support timely patient care approvals. Own quality assurance for approval decisions, resolve escalated cases and appeals, and report approval trends, turnaround times, and denial reasons.
Location: Riyadh
Workplace: Onsite
Employment Type: Full time
Job Function: Solutions Engineering & Sales Engineering
Seniority: Manager level

Key Responsibilities

  • •Set department goals and objectives and cascade them to reporting sections while guiding achievement
  • •Oversee medical service request review and approval, ensuring clinical appropriateness and compliance with medical guidelines and regulatory requirements
  • •Supervise and manage the medical pre-authorization and approval team and provide direction for delegated responsibilities
  • •Ensure compliance with internal protocols, payer policies, and relevant healthcare regulations; train staff on clinical policies, coding, and documentation standards
  • •Resolve escalated cases and appeals with the medical review board or medical director; generate reports on trends, turnaround times, denial reasons, and compliance metrics

Key Requirements

  • •Leverage available information to make decisions in ambiguous situations within the approval function
  • •Adopt new ways of conducting BAU to create agility and move away from traditional approaches
  • •Drive strategic direction by monitoring developments in healthcare that impact section plans
  • •Build team capability by identifying learning opportunities and providing job enrichment
  • •Communicate and monitor KPIs for approval performance, compliance, and service standards
Skills:Decision makingStrategic thinkingLeadershipTeam developmentStakeholder communication

Company Brief

CARE Medical
Provides medical care and healthcare services in Saudi Arabia, likely including patient consultations, clinical support, and related healthcare offerings through its local medical brand and online presence.
Industry: Healthcare Providers
Headquarters: Riyadh, Saudi Arabia
Website