Associate Medical Officer (Doctor)

iCare HMO; Makati; On-site; PHP 1,800,000 - 3,400,000; Full time

Job summary

iCare HMO in the Philippines seeks a senior medical affairs leader to shape strategy and oversee provider relations, clinical governance, and utilization management across the network. This role focuses on improving care quality, cost efficiency, and member satisfaction within a dynamic healthcare environment.

Reporting to the Chief Medical Officer, the Head of Medical Affairs will coordinate credentialing, ensure regulatory compliance, and guide medical decisions while driving preventive health

Qualifications

• Licensed Medical Doctor with current license.
• Preferably with HMO/insurance, diagnostic clinic experience.
• Minimum 5 years of experience as Head of Medical Affairs.

Responsibilities

• Act as co-lead in dealings with provider groups for medical practice matters.
• Ensure provider network meets utilization cost and quality goals.
• Oversee clinic management and coordination with company clinics on utilization management.
• Provide medical guidance for utilization management issues (Prior Authorization, Concurrent Review, Retrospective Review).
• Co-manage the Medical Provider and Services Division, including staff coaching.
• Lead or participate in healthcare programs and preventive health initiatives for clients.

Skills

Leadership

Healthcare management

Provider relations

Regulatory compliance

Education

Licensed Medical Doctor

Tools

Microsoft Excel

Microsoft Word

Microsoft PowerPoint

Microsoft Outlook

Job description

JOB PURPOSE

Participates in strategy development meetings. Work with the Chief Medical Officer (CMO) and Deputy CMO in developing and implementing innovative procedures, regulations, and programs to improve efficiency, quality, and customer service of the Medical and Provider Services Division.

JOB DESCRIPTION

• Acts as co-lead in dealing with provider groups for all medical practice matters. Developing the best possible working relationships between iCare and its Accredited Providers (Doctors/Hospitals/Clinics/Wellness Partners).

  • Ensures provider network meets strategic goals of managing utilization cost while providing high quality healthcare to members of iCare.

  • Initiate, coordinate, attend meetings that relate to Provider credentialing and iCare's compliance with regulatory requirements, etc.

• Oversee the clinic management business/portfolio of iCare and ensure coordination with the company clinics on utilization management initiatives and appropriate care implementation.

• Provides when needed medical guidance and interpretation for all utilization management issues (Prior Authorization, Concurrent Review, Retrospective Review)

  • Guide the MSC and HLO team with the Pre-approval and concurrent review of cases for proper administration of benefits and appropriate care.

  • Provide medical guidance in Claims adjudication as necessary.

  • Conduct Utilization Review with specific accounts.

  • Evaluation of appropriateness of medical care services utilized by the account members.

• Address short term and long-term issues by providing information and medical recommendations pertinent to deliberations, presenting options, and recommending courses of action.

  • May function as the Lead Healthcare Professional to cover services including but not limited to answering medical/clinical inquiries both internal and external.

• Co-manage the Medical Provider and Services Division, which may include but is not limited to interviewing and selection, goal setting, and coaching of staff.

• Participate and lead in appropriate healthcare programs for clients as necessary.

  • Creation of preventive health programs in the corporate setting based on the profile of the clients.

  • Oversee the implementation and management of the Chronic Disease Management Program, Sleep Better Program and other health and wellness initiatives of iCare.

QUALIFICATIONS:

• Licensed Medical Doctor

• Preferably with HMO/insurance, diagnostic clinic experience

• Must have at least (5) years of experience as Head of Medical Affairs

• With above average knowledge on Microsoft Office (excel, word, powerpoint, outlook)