Medical Advisor

3 months ago


Pretoria, South Africa Dymaxa Recruitment Full time

Our client, a non-profit, medical scheme is seeking a **Medical Advisor: Advisory, Risk and Quality Management** in the **Faerie Glen** area.

**Duties include the following, but not limited to**:

- Provide clinical advice to Bestmed and its member regarding hospital benefit and risk management.
- Support and advice for Disease Management and Managed Care Programmes.
- Assess individual cases in accordance with that diagnoses and clinical data motivation letter/benefit structure/Rules of the Scheme/clinical knowledge/experience to facilitate clinical appropriateness of benefits.
- Assess and give input on referrals such as risk management queries and challenges, specific clinical cases, high-cost cases, assessment, and feedback on new technology and to analyse and report on trends and tendencies in the company’s risk management data.
- Ensure Schemes underwriting to new members is in line with CMS requirements.
- Research and development.
- Protocol development.
- Provide clinical advice to Clinical Investigating Officer and Legal Team on CMS complaints.
- Assist with advice on CMS appeals, including but not limited to attending hearings on behalf of the Scheme.

**Requirements**:

- A Degree in Medicine - MBChB (Independent Practice)
- Completed Internship and Community Service
- Registration with Health Professions Council of South Africa
- A minimum of 7 Years’ Managed Healthcare experience in the following - managed healthcare in South Africa, specifically hospital pre-authorisation, case management and account auditing.
- Development of funding guidelines and protocols.
- Development of treatment pathways and defining outcomes.
- Clinical risk software systems and their development.

**Salary**: Market related

**Job Type**: Permanent

**Salary**: From R40 000,00 per month



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