Qureos Mentor

Walaa Cooperative Insurance Co.

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