Medical Approvals Doctor

Required Skills

The Medical Approvals Doctor must be a licensed Medical Doctor (MD) with a strong clinical background, preferably in internal medicine, family medicine, or a related specialty. Experience in medical approvals, utilization review, or health insurance/managed care settings is required, along with strong analytical and decision-making skills, clear communication abilities, and awareness of regulatory and ethical standards. Proficiency in electronic medical records, approval/claims systems, and standard office software is also necessary.

Company Description MediConsult, established in 2004, is a specialized healthcare management company that designs and administers medical care schemes for diverse clients. Combining expertise in health services, financial management, and law, MediConsult focuses on delivering high-quality, confidential, and cost-optimized medical services. The company offers customized medical programs, consultation, and training across multiple medical fields, supported by service categories tailored to different client needs. With a 24/7 call center, nationwide network coverage across Egypt, and a state-of-the-art IT system, MediConsult provides access to leading hospitals, physicians, and comprehensive medical services including inpatient, outpatient, pharmacy, laboratory, radiology, and specialized centers.Role Description The Medical Approvals Doctor is a full-time, on-site role based in El Mohandessin. This role involves reviewing and approving medical requests, treatment plans, and diagnostic procedures in accordance with company policies, clinical guidelines, and clients coverage schemes. The doctor will assess medical necessity, verify documentation, and coordinate with physicians, hospitals, and other providers to ensure appropriate and efficient care pathways. Daily activities include clinical case evaluation, communicating decisions and rationales to the call center and client service teams, and providing medical guidance on complex cases. The Medical Approvals Doctor also contributes to quality assurance, participates in audits and policy updates, and supports training initiatives to maintain high standards of medical decision-making.QualificationsMedical expertise: Licensed Medical Doctor (MD) with strong clinical background, preferably in internal medicine, family medicine, or a related specialty.Healthcare management: Experience in medical approvals, utilization review, or health insurance/managed care settings, with ability to interpret coverage policies and guidelines.Analytical and decision-making skills: Strong clinical judgment, attention to detail, and capability to evaluate medical necessity, treatment options, and risk-benefit profiles.Communication and collaboration: Clear written and verbal communication skills, with ability to explain decisions to medical and non-medical stakeholders and work closely with call center and provider networks.Regulatory and ethical awareness: Commitment to confidentiality, patient rights, and adherence to local healthcare regulations and professional ethics.Technical proficiency: Comfortable using electronic medical records, approval/claims systems, and standard office software; ability to learn new IT tools quickly.Professional attributes: Strong organizational skills, reliability, and ability to manage a high volume of cases while maintaining accuracy and timely responses.Additional advantages: Prior experience in Egyptian healthcare systems, fluency in Arabic and English, and participation in continuous medical education or relevant certifications.