Medical Advisor MMH251017-1

15 hours ago


Centurion, Gauteng, South Africa Momentum Full time

Role Purpose

Managing the delivery of clinical input across the business unit. Overseeing the effective application of evidence based medicine and risk management principles.

Requirements

  • Matric.
  • MBChB or M Fam Med qualification.
  • Registered with HPCSA as a Medical Practitioner.
  • Medical advisory knowledge will be an advantage.

Duties and Responsibilities

  • Medical Advisory work, as directed by the Health Risk Management and Client Execution.
  • Managing the delivery of clinical input across the business unit.
  • Overseeing the effective application of the Health Risk Management clinical policies and protocols 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.

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