Case Management Reviewer

MedNet Egypt is one of the leading managed care service organizations that caters to healthcare needs. We are looking for a skilled Case Management Reviewer who will provide services -mainly through (Phone Calls, Emails, and online) - related to medical evaluation/authorizations for Inpatient insured members/providers and to assist with other administrative issues

Your Job:

• Assess medical necessity and appropriateness for inpatient services and provide authorizations accordingly.
• Perform daily auditing of inpatient claims from the claims department to ensure compliance and accuracy.
• Manage queries via phone, email, and system from providers, insurance companies, and insured members.
• Monitor admitted cases, review treatment plans, ensure cost control, and negotiate with hospitals when needed.
• Review medical procedures against policy terms and international medical guidelines (e.g., Medscape, Mayo Clinic).
• Discuss treatment plans with physicians and arrange second opinions where needed for validation.
• Deliver responsive, high-quality service to clients to maximize satisfaction and adherence to SLAs.
• Guide patients to optimal care options and maintain a referral matrix of preferred providers.
• Compile daily, weekly, and monthly reports on departmental performance, savings, and medical trends.
• Maintain accurate and updated medical records, investigation results, and approval files.
• Support the development of tools to streamline the case management cycle and pricing benchmarks.
• Respond to inpatient requests and queries from international insurance accounts professionally and efficiently.

Your Profile

• Bachelor's degree in medicine (essential); 2–4 years field experience.
• Previous exposure to medical call centers, claims handling, or case management within a TPA or insurer is a plus.
• Proficient in MS Office (Word, Excel, PowerPoint); database management experience.
• Familiarity with local healthcare services and provider networks is an advantage.
• Excellent written and verbal English; strong interpersonal and negotiation skills.
• Analytical Thinking
• Organizational Skills
• Decision-Making skills
• Customer-Centric Mindset