Case Management Reviewer

About the role

MedNet Egypt is seeking a skilled Case Management Reviewer to evaluate inpatient medical requests, authorize services, and ensure compliance with clinical guidelines. The role involves daily interaction with providers, insurers, and members through phone, email, and online platforms.

Key responsibilities

• Assess medical necessity and appropriateness for inpatient services and issue authorizations.
• Audit inpatient claims daily to verify accuracy and policy compliance.
• Handle queries from providers, insurance companies, and insured members via phone, email, and system.
• Monitor admitted cases, review treatment plans, control costs, and negotiate with hospitals when required.
• Review procedures against policy terms and international medical guidelines (e.g., Medscape, Mayo Clinic).
• Discuss treatment plans with physicians and arrange second opinions for validation.
• Provide high‑quality, responsive service to meet SLA targets.
• Guide patients to optimal care options and maintain a preferred‑provider referral matrix.
• Prepare daily, weekly, and monthly performance, savings, and trend reports.
• Maintain accurate medical records, investigation results, and approval files.
• Support development of tools to streamline case‑management processes and pricing benchmarks.
• Respond professionally to inpatient requests from international insurance accounts.

Required profile

• Bachelor’s degree in medicine (essential).
• 2–4 years of relevant experience in medical call centers, claims handling, or case management (TPA or insurer preferred).
• Familiarity with local healthcare services and provider networks is an advantage.
• Excellent written and verbal English communication skills.

Required skills

• Proficiency in Microsoft Word.
• Proficiency in Microsoft Excel.
• Proficiency in Microsoft PowerPoint.
• Database management experience.

What we offer

• Opportunity to work within a leading managed‑care organization.
• Exposure to international insurance accounts and diverse medical cases.
• Professional development in case‑management and healthcare analytics.