Lead the development, implementation, and continuous improvement of clinical guidelines, training programs, and clinical rules automation to ensure high-quality, evidence-based patient care. This role will focus on enhancing clinical decision-making, ensuring compliance with regulatory policy, and optimizing operational efficiency through strategic guideline management and staff education
Development and Implementation of Clinical Guidelines
Design, develop, and implement evidence-based clinical guidelines aligned with regulatory requirements.
Conduct regular reviews and updates of clinical guidelines to reflect the latest medical evidence and industry best practices.
Collaborate with clinical leaders and subject matter experts to ensure guideline relevance and effectiveness.
Training and Education Programs
Develop comprehensive training programs for BCC & BA medical staff on clinical guidelines, coverage policies, and decision-making protocols.
Organize regular workshops, e-learning modules, and competency assessments to maintain high standards of clinical practice.
Evaluate training effectiveness and implement continuous improvements based on feedback and performance outcomes
Monitoring Adherence and Clinical Quality
Establish monitoring systems in collaboration with QI to assess compliance with clinical guidelines across BCC & BA.
Provide regular reports on guideline performance and adherence trends.
Lead the development & validation of clinical edits and rules for claims/ PA auto-adjudication, ensuring accuracy and alignment with clinical guidelines.
Continuously review and update rules to reflect changes in clinical guidelines and regulatory standards
Collaboration with Healthcare Providers
Work closely with the Population Health, Quality Improvement, and Digital Innovation teams to align clinical guidelines with broader healthcare strategies.
Engage with regulatory bodies to ensure compliance with CHI and IA published guidelines
Patient Safety and Satisfaction
Promote patient safety and satisfaction through effective guideline implementation.
Integrate patient safety measures into clinical guidelines and training programs.
Collect and analyze patient feedback related to care quality and adherence to guidelines.
Address any identified gaps in patient safety and ensure timely updates to guidelines
Professional Development and Compliance
Stay updated on emerging healthcare trends, regulatory changes, and best practices in clinical governance.
Ensure ongoing professional development and compliance with regulations.
Stay updated on changes in clinical guidelines, regulatory requirements, and best practices.
Facilitate opportunities for continuous education and professional development for clinical staff.
Conduct audits to ensure compliance with clinical guidelines and regulatory standards
Skills:
MBBS or MD degree from accedited school
Master's degree in healthcare, public health, or a related field
Strong understanding of clinical guidelines, evidence-based medicine, and regulatory compliance.
Proficiency in data analysis and reporting tools to monitor adherence and outcomes.
Proven leadership and project management abilities.
Excellent communication, facilitation, and interpersonal skills.
Proficiency in Microsoft Office Suite and Power BI
Proficiency in Arabic and English languages
Education:
Medicine and Surgery
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