Description

Job Description

As a member of Munich Re the MedNet Global Health Care Solutions L.L.C. is one of the leading managed care service organizations that caters to healthcare we are currently looking to hire a Medical Reviewer who is specialized for In-patient cases and responsible for performing clinical evaluation, case management, and utilization review for insured members requiring inpatient and selected outpatient services. The role ensures appropriate medical necessity, alignment with policy terms, and cost‑effective care pathways, while contributing directly to improved loss ratios, quality of care, and fraud‑waste‑abuse control.

Your Job:

• Medical Evaluation & Pre-Authorization – Assess inpatient and outpatient requests for medical necessity and policy compliance.
• Clinical Review & Treatment Assessment – Review treatment plans, diagnostics, surgeries, medications, and length of stay (LOS).
• Case Management & Discharge Planning – Manage inpatient cases to optimize LOS and ensure effective discharge planning.
• Cost Containment Strategies – Recommend clinically appropriate, cost-effective alternative treatment settings.
• Clinical Risk Assessment – Evaluate chronic and high-risk cases to support underwriting decisions.
• Stakeholder Communication – Communicate medical decisions clearly to providers, members, and internal teams.
• Fraud, Waste & Abuse Control – Identify suspicious cases and escalate for investigation, including provider visits when required.
• Reporting & Utilization Analytics – Prepare monthly reports and analyze utilization trends to identify cost drivers and improvement areas.

Your profile:

Minimum Qualifications:

• MBBS / MD.

Minimum Experience:

• 2-3 years’ experience in IP Authorization in a TPA/Insurance Company or in a Healthcare Provider.
• Understanding of GCC healthcare systems.
• Strong medical knowledge and coding familiarity.
• Strong communication and decision‑making.

*Munich Re not only stands for fairness with regard to its clients; it is also an equal opportunity employer.