Clinical Advisor
1 week ago
In this role, the Clinical Advisor will seek to align clinical solutions with clinical and business objectives and build relationships and credibility with key stakeholders effectively.
Duties will include but not be limited to:
- Serving as the clinical expert providing technical support to the Managed health care department
- Contributing to the refining and adapting of Managed health care processes, policies and protocols
- Policy development and supporting clinical research to be in line with the best practice in health management
- Meeting or exceeding client needs by developing and delivering insightful, value-added solutions that address complex client issues
- Devising and executing a plan to establish provider networks
- Creating and executing upon an annual business plan that aligns with achieving monthly, quarterly, and annual quota and goals
- Ensuring managed care contracts include required contract language for different payment models to include risk, maximize revenue and minimize risk and address impacts to utilization management, claims processing, and contract performance monitoring
- Providing clinical validation to requests made by healthcare providers on behalf of our members for high cost procedures and medication
- Provide clinical leadership and guidance to the business through involvement and support of clinical and nonclinical committees
**Requirements**:
- MBChB, experience in managed healthcare environment preferable
- Minimum requirement Bachelors degree in the medical field
- Business Administration/Management post graduate qualification would be an advantage
- Minimum of 4-7 years administrative management experience in Managed Care, Insurance or Healthcare Administration
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