Medical Advisor

2 weeks ago


Johannesburg, Gauteng, South Africa AfroCentric Group Full time
Job title : Medical AdvisorJob Location : Gauteng, JohannesburgDeadline : April 28, 2025Quick Recommended Links
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Position Purpose

  • To ensure that the scheme or organisation is protected from over-utilisation or inappropriate claiming by service providers that leads to abuse of member and scheme funds.

Qualifications

  • Relevant medical degree, relevant qualification should be a MBChB degree.

Experience

  • 6 - 8 years Managed Care experience preferred

Accountabilities

Continuous improvement:

  • Provide clinical inputs on ex-gratia funding requests
  • Open, review and resolve all clinical queries and assessments through providing a clinical decision or requesting more information where required
  • Implement practical solutions that use the specialist and departmental systems and processes
  • Provide specialist input and recommendations to improve the efficiency, compliance and quality objectives related to the area of specialisation
  • Identify problems and develop and propose solutions to present to appropriate leader or stakeholders
  • Ensure day to day operational support required from area of specialisation is provided to enhance performance

Cost containment:

  • Support the identification, development and implementation of cost-effective processes to increase efficiency and reduce cost drivers related to area of specialisation
  • Continuously review cost / benefit and Return on Investment within area of specialisation

Drive customer-centricity:

  • Engage with providers and pre-authorisation agents to build informed and supportive mutual relationships
  • Maintain a high level of impact on other departments to support improved delivery
  • Continually increase understanding of client and stakeholder needs, satisfaction and service delivery.

Knowledge management:

  • Assess all high risk or high cost medical procedures to ensure appropriate authorisation and claiming is facilitated
  • Provide clinical training / support to identified stakeholders
  • Provide medical advisory services to relevant parties
  • Ensure that adequate knowledge regarding specialisation is shared as required and maintained within the research library
  • Provide advice and / or training as required
  • Maintain, develop and implement specialist knowledge within the day to day operations of the organisation.

Maintain expertise level:

  • Be a member of related professional bodies
  • Ensure CPD (continual professional development) or similar accreditation requirements are met annually to ensure maintained specialist accreditation.

Network key relationships:

  • Engage with and provide support to the established network of internal and external expert resources and partners.

Specialist support to projects:

  • Provide Specialist expertise and ensure best practice related to specialisation is implemented in projects, when required
  • Conform to project management disciplines when participating in projects
  • Represent department or project on appropriate committees related to area of specialisation.

Competency Requirements

Knowledge:

  • Knowledge and application of relevant legislation
  • Knowledge of device industry
  • Ability to provide appropriate medical direction and advisory services
  • Knowledge and application of clinical principles and processes
  • Knowledge of clinical and funding protocol development
  • Clinical research and assessment
  • Knowledge of scheme rules and contractual negotiations

Skill:

  • Analytical skills
  • Business Writing Skills
  • Communication Skills
  • Computer Technology Skills
  • Attention to Accuracy and Detail
  • Problem solving and decision making skills
  • Numerical Ability
  • Customer Focus
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