Medical Advisor

Kaelo; Gauteng; On-site; ZAR 600 000 - 900 000; Full time

Job summary

A healthcare solutions provider in South Africa is seeking Medical Advisors to ensure adherence to clinical standards and provide excellent patient care. Responsibilities include supervising clinical staff, managing regulations, and engaging with healthcare professionals. Ideal candidates will possess a Medical Degree, registration with HPCSA, and 4+ years of clinical experience. Strong communication and organisational skills are essential for fostering teamwork and decision-making. Join a dedicated team focused on quality healthcare delivery.

Qualifications

• 4+ years of clinical experience required.
• Exceptional interpersonal skills necessary.
• Strong understanding of medical procedures and terminology.

Responsibilities

• Ensure quality medical care standards are met.
• Supervise clinical and non-clinical staff to ensure proper procedures.
• Participate in the Clinical Review Committee decision making.

Skills

Organisational Skills

Communication Skills

Decision Making Skills

Negotiation Skills

Strategic Planning Skills

Interpersonal Skills

Education

Medical Degree

Valid registration with HPCSA

Master of Health Administration (MHA)

Master of Business Administration (MBA)

Job description

Company Description

Kaelo provides essential healthcare solutions ensuring the physical and psychosocial wellbeing of all South Africans towards lasting social change. Kaelo meets the Healthcare needs of Corporate and Retail clients across South Africa – products offerings include Medical Insurance, Medical Aid, Gap Insurance, Kaelo Money and employee assistance programmes.

Job Description

Medical Advisors are responsible for ensuring that the Scheme Administrator and Managed Healthcare Organisation adheres to clinical and safety standards. Medical Advisors are expected to engage with the Scheme Administrator, Managed Healthcare Organisation and treating healthcare professionals to ensure the highest quality of evidence based medical care is delivered to patients. They are expected to carry out their duties with patience and confidence.

Responsibilities

• Ensuring that patients receive the highest standard of medical care.
• Encourage a high standard of performance from clinical staff.
• Ensuring that all healthcare regulations and safety standards are met.
• Keeping staff updated on new healthcare regulations.
• Ensuring appropriate risk management without compromising quality of care.
• Liaising between administration and medical staff.
• Participate in decision making on the Clinical Review Committee.
• Assist with the review, update, and feedback of clinical queries and escalations.
• Participate and review CMS circular for clinical input.
• Participate in annual CMS Accreditation submissions.
• Annual review of all clinical protocols to ensure they are updated.
• Annual review of all formularies.
• Responsible for liaising with treating providers for admission updates, treatment plans, discharge or referral.
• Analyse healthcare spend and make recommendations for enhancements and or changes.
• Reporting to the Health Executive.

Key Outcomes

• Ensure delivery of appropriate cost efficient care without compromising quality of care.
• Ensure that, as a Managed Care Organisation, Prime Cure complies with all regulations by the respective governing bodies including Council for Medical Schemes.
• Provide clinical input into the appropriate care of patients.

Support Clinical Staff

• Supervise the clinical team including non-clinical staff to ensure that proper procedures are being followed and that evidence based medicine is being put into practice.

Develop and Maintain Clinical Policies, Procedures and Protocols

• Develop and maintain Clinical Protocols and SOPs.
• Regular review of medication formularies.
• Regular review of Maternity program
• Regular review of HIV program.

Review Patient Complaints

• Review patient complaints and concerns raised through all channels in the business.
• Review patient surveys, and adjust policies as necessary.

Qualifications

REQUIRED

• Medical Degree
• Valid registration with the relevant professional body – HPCSA.
• Good Organisational Skills
• Excellent Written and Verbal communication skills
• Exceptional interpersonal skills
• PMB or Medical Scheme Administration

PREFERRED

• Master of Health Administration (MHA)
• Master of Business Administration (MBA)

Work Experience

4+ years Clinical Experience

• Physicians with a strong understanding of medical procedures, equipment, and terminology.

Additional Information

REQUIRED

• Decision Making Skills
• Organisational Skills
• Communication Skills
• Negotiation Skills
• Strategic Planning Skills
• Ability to work well within a team
• Ability to work under stress and tight deadlines

PREFERRED

• Knowledge of the Healthcare Industry