Qureos Mentor

Walaa Cooperative Insurance Co.

<div>
 
 
 Duties and Responsibilities:
 
 
 
 Managing a group of hospitals to ensure that inpatient customers are receiving optimal healthcare within agreed quality parameters. The Roving Doctor provides medical expertise across multiple sites ensuring high-quality patient care, compliance with medical standards, and support for clinical teams. This role involves regular travel, flexibility, and the ability to work in diverse healthcare settings.
 
 <ul>
 <li>
 Consultants and Medical Directors at Providers
 </li>
 <li>
 Collaborate with consultants at providers to agree on case management plans.
 </li>
 <li>
 Monitor all inpatient cases closely on a daily basis.
 </li>
 <li>
 Escalate critical issues to the provider's medical management team as needed.
 </li>
 </ul>
 
 
 Insurance Offices and Provider Management:
 
 
 <ul>
 <li>
 Ensure approvals and rejections are mutually agreed upon.
 </li>
 <li>
 Verify that invoicing aligns with the terms of the agreement.
 </li>
 </ul>
 
 
 Customer Care:
 
 
 <ul>
 <li>
 Maintain communication with inpatients and their families to enhance the company&rsquo;s image.
 </li>
 <li>
 Proactively address and resolve any issues faced by customers or their families at the hospital.
 </li>
 </ul>
 
 
 Hospital Admissions:
 
 
 <ul>
 <li>
 Provide accurate and detailed daily updates on all inpatient cases, including justifications for decisions made.
 </li>
 </ul>
 
 
 Reporting:
 
 
 <ul>
 <li>
 Submit reports on savings and fraud to Medical Approvals Manager.
 </li>
 <li>
 Notify Provider Relations of high-value claim cases.
 </li>
 <li>
 Market Practices reporting
 </li>
 <li>
 Proactively gather and report insights on provider and competitor practices to the regional team.
 </li>
 </ul>
 
 
 Compliance and Ethics:
 
 
 <ul>
 <li>
 Ensure all medical practices align with local healthcare regulations and ethical standards.
 </li>
 <li>
 Promote patient safety and confidentiality across all facilities.
 </li>
 </ul>
 
 
 Medical Auditing and Oversight:
 
 
 <ul>
 <li>
 Review patient files for accuracy, completeness, and compliance with organizational standards.
 </li>
 <li>
 Identify gaps in documentation and recommend corrective actions.
 </li>
 <li>
 Support the approvals and claims team in reviewing and validating medical necessity for services
 </li>
 </ul>
 
 
 Education:
 
 
 <ul>
 <li>
 Bachelor&rsquo;s degree in medicine.
 </li>
 <li>
 Preferably diploma or masters in a clinical specialty.
 </li>
 </ul>
 
 
 Experience:
 
 
 <ul>
 <li>
 2 years of experience in same roving role or active medical practice.
 </li>
 <li>
 Familiarity with health insurance industry practices, policies, and regulations.
 </li>
 </ul>
 
 
 Personal Attributes / Skills:
 
 
 <ul>
 <li>
 Strong diagnostic and clinical decision-making skills.
 </li>
 <li>
 Excellent communication and interpersonal skills.
 </li>
 <li>
 Ability to work independently and adapt to diverse environments.
 </li>
 <li>
 Proficiency in electronic medical record (EMR) systems and reporting tools.
 </li>
 <li>
 Familiarity with healthcare policies, medical insurance processes, and claims adjudication.
 </li>
 <li>
 Willingness to travel frequently and work flexible hours.
 </li>
 </ul>
 
 
 Others:
 
 
 <ul>
 <li>
 Excellent Communication and negotiation skills.
 </li>
 <li>
 Extensive and updated medical know-how.
 </li>
 </ul>
 
 
</div>

Roving Doctor

Join Walaa Cooperative Insurance Co. and explore 1   exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.

Walaa Cooperative Insurance Co.

About Company

Roving Doctor