Medical Advisor
4 months ago
**Introduction**
- Momentum Health Solutions, an entity of Momentum Metropolitan Holdings delivers sustainable, integrated health solutions that meet the needs of clients in the different segments and maximise lifetime client value. We build and maintain a culture of innovation, and create value through unique insights of how to achieve specific outcomes by using a defined set of Health capabilities.**Disclaimer**
- As an applicant, please verify the legitimacy of this job advert on our company career page.**Role Purpose**Requirements**:
- Matric
- MBChB or M Fam Med qualification
- Registered with HPCSA as a Medical Practitioner
- Medical advisory knowledge will be an advantage
- Previous medical advisory experience will be an advantage.
**Duties & Responsibilities**
- Medical Advisory work, as directed by the Health Risk Management and Client Execution.
- Managing the delivery of clinical input across the business unit.
- Training of case managers, pharmacists and/or pharmacist assistants in case forums.
- Attendance of Medical Advisors meetings.
- Relevant work to be done with reference to medical scheme rules and within the parameters of relevant coding rules and Evidence Based Medicine.
- Supporting the development of guidelines and protocols for the Health Risk Management according to the standards prescribed by the Head of Clinical Policy.
- Review of the pathology, radiology and Prescribed Minimum Benefit (PMB) claims and maintenance of the tariff files in conjunction with the coding team.
- Provision of clinical input and presentation of ex-gratia cases on a monthly basis at client Clinical forums.
- Generation and analysis of product specific reports on a monthly basis.
- Management of the benefit design requirements for identified schemes as it relates to clinical input.
- Build and maintain relationships with clients and stakeholders that promote cross delivery practice solutions.
- Contribute to sustaining a competitive edge through external networking and benchmarking and representation on related forums.
**Competencies**
- Interpreting Data
- Examining Information
- Managing Tasks
- Making Decisions
- Providing Insights
- Taking Action
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