Medical Doctor

2 weeks ago

Lahore, Punjab, Pakistan Blue Health Full time 1,500,000 - 4,500,000 per year

Blue Health is seeking a
qualified and detail‑oriented Medical Doctor for Prior Authorization
a medical doctor role situated fully within a
non‑clinical environment
. This key position involves evaluating and validating requests for medical services, procedures, diagnostics, and prescriptions to ensure they align with established clinical guidelines before approval.
Prior authorization
refers to the administrative process of verifying that requested medical interventions are
medically necessary and appropriate
prior to authorization.

The Medical Officer will critically assess clinical documentation submitted by healthcare providers, apply sound medical judgment to determine necessity, and collaborate closely with internal teams to streamline decision-making, all while operating outside of direct patient care.

Key Responsibilities

  • Review and evaluate prior authorization requests for treatments, diagnostic tests, surgeries, and medications against predefined clinical criteria.
  • Analyze patient histories and supporting clinical documentation to ensure compliance with relevant protocols.
  • Apply non‑clinical, evidence‑based medical judgment to approve or decline requests.
  • Collaborate with internal teams to maintain consistency, accuracy, and quality throughout the authorization process.
  • Maintain detailed and accurate records of authorization decisions and case evaluations.
  • Participate in quality improvement initiatives and process refinement discussions to enhance overall workflow efficiency.

Requirements

  • Medical Doctor (MBBS or MD) with strong experience in prior authorization, medical review, or clinical decision‑making
  • Proficiency in English—both written and verbal communication is crucial.
  • Exceptional analytical and critical thinking abilities, with meticulous documentation skills.
  • Comfortable working in a dynamic, collaborative, non‑clinical environment.

Qualifications

  • MBBS / MD degree from a recognized and accredited medical institution (mandatory).
  • Familiarity with clinical documentation systems and digital medical review platforms.

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