Senior Manager, Medical Care Operation, Sports Management and Internal Governance
Bupa Arabia
مجموع سنوات الخبرة :17 years, 10 أشهر
Led 3 different units and reported directly to the medical director to achieve the following tasks:
• Medical care operations; monitoring and managing the reported unfavourable outcomes and hospital complications of all insured members. Assist the medical director to decide on hospital liabilities regarding the reported cases. Communicating with the department heads and medical directors of health care providers to decide on the root cause analysis of the reported cases and finding necessary actions to eliminate recurrence. Communicating with external parties as MOH and patient safety centre when necessary.
• Sports management; management of all related aspects of the football first team of Bupa’s sports partners (Al Itihad Sports Club and Al Hilal Sports Club) including management of sports injuries inside and outside KSA. Deciding on the preferred network and health care providers at different sub-specialities. Running the pre-competition medical assessment and mid-seasonal assessment for both teams and fulfilment of compulsory documentation to participate at Asian and International competitions. Ensure performance enhancement of both teams through regular medical checkups, dental checkups, vaccination, foot scan and insoles and conducting regular health awareness sessions in relation to different sport injuries.
• Internal governance; Led the clinical governance committee to give final decisions in all medical and policy queries and debates related to the standard CCHI policy. Achieve a common understanding and unified decisions of all medical teams inside Bupa Arabia. Communicating the CCHI when needed.
Supported the marketing /Actuarial teams in designing extra health benefits packages (beyond the standard CCHI coverage) including health benefits, exposure, cost, and proposed prices.
• Create a monitoring dashboard to understand the trends of utilization and consumption.
• Support in the development of products/solutions to support the growth of the company.
• Support developing pricing strategy across various product lines to position the products based on value and competitive situation.
• Support the pricing process for the organization while ensuring compliance by controlling the exemption process.
• Support sales teams in presenting health care benefits to customers and channel partners.
• Being a member of the subject matter expert team for all aspects related to the Pricing of health care services
Led a team of 14 physicians to achieve the following tasks:
• Ensure the quality of medical services delivered to Bupa Arabia ensured patients inside the top 30 health care providers.
• Regular patient and clinical governance committee.
• Contribute to develop adopted clinical practice guidelines based on internationally recognized references to ensure patient safety and protect the organization from fraud and abuse.
• Interacting, coordinating with consultants, medical directors and insurance managers to agree on case management plans and to ensure close follow up of impatient cases.
• Engagement with patients and family members to ensure compliance and acknowledgement of post discharge management plan.
• Management of home health care plans and referral decisions of necessary cases at western region.
Led a team of 19 physicians and medical officers to achieve the following tasks:
• Medical cost & services management.
• Ensure Quality medical decision & patient safety.
• Efficiency management and Operation excellence.
• Capability building & people management.
• Support the business & communicate effectivity.
• Compliance to policy & regulation.
Responsible for contacting the members and treating physicians for further discussion of rejected and pended cases and giving the final decision upon medical and policy scenarios.
Handled multi-tasks at the same time which included:
• Companies Relation Manager
• Head of claim review unit
• Responsible for the integration of the online systems with insurance companies. (under oracle data base 10g)
Handled multi-tasks at the same time which included:
• Companies Relation Manager
• Operational Manager
• Head of claim review unit
• Marketing Manager
• Acting head of admission office
• Supervisor of Customer service and patient relations offices
• Responsible for the integration of the online systems with insurance companies. .(under oracle data base 8i)
Promoted to handle the following tasks:
• Field doctor
• Supervised approval section and claim review unit
• Providers affairs manager
• Assistant medical director