CLINICAL AUTHORIZATION MANAGER

Description

Job Summary: Manage clinical authorization processes, ensuring appropriate use of resources, quality of care, and compliance with regulations. Key Highlights: 1. Efficient management of clinical authorization processes 2. Management of complex cases and technical support 3. Participation in technical and multidisciplinary committees Ensure efficient management of clinical authorization processes, guaranteeing appropriate use of resources, quality of service to beneficiaries, and compliance with technical, contractual, and regulatory standards. **Responsibilities and Duties** * Manage authorization processes for procedures, hospitalizations, examinations, and therapies. * Define and monitor technical criteria for clinical authorizations, based on evidence and clinical guidelines. * Ensure compliance with ANS regulations and those of other regulatory bodies. * Monitor performance indicators (authorization turnaround time, denial rates, judicialization, clinical cost, etc.). * Manage complex cases and provide technical support to clinical and service teams. * Support clinical cost-control strategies without compromising quality of care. * Participate in technical and multidisciplinary committees. **Requirements and Qualifications** * Bachelor's degree in Administration or Health Sciences. * Postgraduate degree in Health Auditing, Health Management, or related fields is desirable. * Solid experience in clinical regulation, health auditing, or health insurance operations. * Knowledge of OPME (Orthopedic, Prosthetic, and Dental Materials) and OPME management. * Familiarity with ANS legislation. * Experience managing teams. **Additional Information** **Working Hours:** 8:00 AM to 5:48 PM — Monday to Friday. We are a strong, experienced group driven by health. The DC Group is a platform of independent brands and services united by a shared purpose: **providing health solutions for people.** **STRENGTH. HEALTH. KNOWLEDGE.** These three pillars guide our actions. It is from this foundation that our companies grow and increasingly distinguish themselves in their respective fields. With ethics, social commitment, and continuous evolution, we continue promoting quality of life, facilitating and simplifying access to healthcare, and innovating in the management of our processes and services. **We are the DC Group—and here, we breathe health.**