Team Leader - Quality

MedNet Egypt is one of the leading managed care service organizations that cater to healthcare needs. We are looking for a skilled Team Leader - Quality who will be responsible for providing quality services-mainly through KPIs review & process review and authority matrix related to medical evaluation across the HUB platform including authorizations and Assess quality of Hub team in terms of authorizations and communication with stakeholders to ensure excellent service delivered.

Your Job

• Provide overall guidance about the medical cases review, evaluation and authorization activities ensuring compliance with established policy guidelines.
• Review all KPIs & SLAs and process in place for al reviewed authorizations and claims.
• Monitor and review the pre-authorization and claims process in terms of TAT and accuracy “technical and medical”.
• Weekly and monthly following up the team’s performance regarding quality projects, representing all quality projects and team’s quality score in form of dashboard on monthly basis.
• Develop and distribute regular audit reports to the team members outlining the audit findings with flagging critical findings that require immediate attention and/or management intervention.
• Monitor and validate team members communication with stakeholders in terms of authorizations, replies, support in complaints investigation & solution process.
• Coordinate with other work streams in UAE & Oman to evaluate and communicate with claims team through getting their feedback constantly, authority approval, share reports, revise and validate Call Center issues related to medical team.
• Coordinate with Authorizations and fronting team to check the SMO and CM process and escalations and collect and investigate received findings for corrective action and data enhancement.
• Develop and/or recommend training programs for the team members to address error trends and its corrective actions via several training materials (Video Records, Medical and Technical sessions, Guidelines manual, ...).
• Review queries received from PICs and stake holders related to Hub team activities.
• Identify gaps and leakage areas and recommend the needed training for these areas.
• Compile data and prepare statistical reports on weekly & monthly basis to monitor Hub Team performance in term of Quality.

Your Profile

• Bachelor’s degree in Medicine, Pharmacy or Dentist.
• From 3-5 years' experience in his/her educational field.
• Computer literacy (MS Office, Excel, PowerPoint)
• Industry knowledge related to local healthcare services system would be a plus.
• Time management skills.
• Database management skills
• Good command in English
• Good interpersonal and negotiation skills
• Excellent written and verbal communication skills
• Strong leadership, planning and organizational skills
• Analytical and problem-solving skills
• Decision Maker.