Manager – Medical Information (PHM)
Job Description
Generate & maintain Bupa Arabia (BA) / Bupa CareConnect (BCC) clinical guidelines. Design & engineer up-to-date clinical care pathways and govern all value-based initiatives across BA & BCC. Contribute to the medical educational activities needed within BA/BCC to improve the clinical knowledge & policy interpretation across BA/BCC. Arbitrate & manage complex cases including regulatory complaints
Medical Guidelines development
Conduct the required scintific research for all the required data in developing the medical guidelines for BA/BCC and have the right knowledge and skills to ensure obtaining the correct information. Maintain all the current guidelines up-to-date and generate a periodic new version to ensure the availability of the new version to all BA & BCC users. Ensure the validation of all newly published guidelines while securing their publication onto the appropriate data broadcasting platforms. Trace the international societies and medical journals for any new updates with regards to new clinical interventions. Keep track and report all validated and published guidelines
Population Health Management (PHM)
Collaborate with the concerned departments to identify baseline measures of treatment costs and health status. Identify specific subgroups that are outliers on cost and outcome metrics and define changes to their care processes. Design clinical care pathways for the defined groups by conducting thorough literature review for the selected medical conditions. Articulate Medical Scripts to be used as tools of health promotion. Contribute in the development and governance of value based bundle models. Set clinical goals, monitor the health outcomes of designed programs, evaluate the impact of the clinical interventions, and make the necessary adjustments to optimize outcomes. Conduct the required training for all internal & external stakeholders upon the publication of each designed clinical pathway. Participate in national forums with regulators & NGOs to in relation to population health management initiatives. Collaborate with the proper teams to optimize system functionality in managing PHM.
Clinical Effectiveness
Arbitrate the QDI forum in collaboration with TQM & other medical departments. Conduct regular Medical Educational Programs for BA/BCC (example: medical quiz). Monitor and report performance and outcome, while initiating the necessary intervention to optimize medical education. Collaborate with Training and Development to enhance the training modules for BA/BCC medical staff
Regulatory Management
Lead regulatory requirements on behalf of BA/BCC. Assess escalated regulatory complaints by reviewing the given data, defining the exact concern, assessing the relevance & quality of the data, categorizing evidence according to the strength of recommendation & summarize evidence into a Rapid Response Guideline. Initiate internal discussions/meetings with relevant departments to discuss disputed cases. Formulate case studies that can be used for educational purposes in addition to regulatory discussions
Medical Decision making
Lead the review of all medical enquiries & complex cases escalated to medical department. Track all cases adjudicated outside the documented guidelines as part of building BA/BCCs “Stare decisis”. Ensure adherence to all policy and medical rules in each decision making
Skills
Internal or Family Medicine board certified or Masters in population/ public health is preferred. Medical research. Population Health Management. Medical Education. Quality Management. Excellent communication skills, in both written & spoken English & Arabic
Education
Medicine and Surgery
Job Location Jeddah , Saudi Arabia Job Role Doctors Years of Experience Min: 3
