Medical Advisor

Discovery Limited; Cape Town; On-site; ZAR 550 000 - 700 000; Full time

Job summary

A leading health and wellness company based in Cape Town is looking for a qualified Medical Advisor to make funding decisions for clinically complex cases. This role requires excellent communication skills and knowledge of managed care. Ideal candidates will have a medical background with at least two years in a hospital or clinic setting. Responsibilities include providing clinical support across various teams and engaging with external clinical providers. This position promotes quality healthcare while adhering to evidence-based principles.

Qualifications

• Minimum of two years experience in a private hospital or clinic.
• Knowledge of prescribed minimum benefits.
• Clinical coding knowledge of ICD-10.

Responsibilities

• Provide clinical support to various business areas.
• Communicate funding decisions to relevant parties.
• Maintain relationships with external health care providers.

Skills

Knowledge of managed care environment

Excellent written and verbal communication skills in English

Basic computer literacy in Microsoft Office

Education

Qualified Medical Doctor

Full and Current HPCSA registration – Independent Practice

Matric

Job description

Medical Advisor

Discovery's core purpose is to make people healthier and to enhance and protect their lives.

Business Unit

Discovery Health

Function

Clinical

Clinical Benefit Advisory Team

The Clinical Benefit Advisory Team (CBAT), a subsidiary of Discovery Health, comprises Medical and Legal Advisors who offer clinical and legal expertise on complex cases. The Council Liaison Managers serve as the bridge between Discovery Health and the Council for Medical Schemes, providing support to the Legal Advisors. Additionally, the Medical Review Consultants ensure that clinical cases are thoroughly reviewed, and appropriate decisions are made. The team operates regionally in Sandton and Cape Town.

Key Purpose

This position requires the successful candidate to be able to make funding decisions for clinically complex cases as per scheme rules, in keeping with principles of evidence based medicine while promoting cost effective and quality healthcare for our members and managing interactions with external clinical providers.

Responsibilities

• Provide clinical support to the Medical Review team, PMB team, Chronic Illness Benefit, hospital case management, oncology case management, exec office, benefit compliance review, the underwriting and forensics area, and other business areas.
• Ensure the workflow pools and TWT are met.
• Participate in key clinical forums internally and externally.
• Daily Clinical Review – Prepare cases, present cases, load member remarks and clinical exceptions, arrange second opinions / external expert opinion and follow up.
• Communicate funding decisions to the relevant parties.
• Keep abreast with legislative and industry changes and how they affect your business unit.
• Stay updated with the latest clinical thinking and attend CPD events.
• Identify new trends in the medical industry, and engage with relevant clinical stakeholders.
• Maintain constant interaction and relationship building with external health care providers.
• Maintain a database of funding decisions made.
• Support junior staff and other medical advisors.
• Assist with claims, coding and payment resolutions.
• Identify operational gaps and initiate improvement strategies.
• Apply clear knowledge of evidence based medicine and review clinical evidence on a case by case basis.
• Liaise with various business group TWGs.

Knowledge and Skills

• Knowledge of managed care environment.
• Sound knowledge of prescribed minimum benefits.
• Excellent written and verbal communication skills in English.
• Basic computer literacy in Microsoft Office applications (must be proficient in Excel).

Role Specific Behaviours

• Action oriented
• Attracts top talent.
• Business insight
• Directs work.
• Cultivates innovation.
• Interpersonal savvy
• Nimble learning
• Organizational savvy
• Plans and aligns.
• Situational adaptability
• Strategic mindset
• Tech savvy
• Drives vision and purpose
• Optimizes work processes

Education and Experience

The following requirements are essential:

• Matric
• Qualified Medical Doctor
• Full and Current HPCSA registration – Independent Practice
• Minimum of two years experience in a private hospital or clinic.

The following requirements will be advantageous:

• Previous Medical Advisor or managed healthcare experience.
• Knowledge of DH SOP's and process experience (internal only).
• Clinical coding knowledge of ICD-10.

Personal Attributes

• Values Driven
• Learns on the Fly
• Resilient
• Instills Trust
• People Savvy
• Drives Results

Employment Equity

The Company's approved Employment Equity Plan and Targets will be considered as part of the recruitment process. As an Equal Opportunities employer, we actively encourage and welcome people with various disabilities to apply.