Medical Advisor

Ensuring that the scheme or organisation is protected from over-utilisation or inappropriate claiming by service providers that leads to abuse of member and scheme fund.

Key Accountabilities

1. Provide clinical inputs on ex-gratia funding requests - Open, review and resolve all clinical queries and assessments through providing a clinical decision or requesting more information where required.
2. Implement practical solutions that use the specialist and departmental systems and processes.
3. Provide specialist input and recommendations to improve the efficiency, compliance and quality objectives related to the area of specialisation.
4. Identify problems and develop and propose solutions to present to appropriate leader or stakeholders.
5. Ensure day-to-day operational support required from area of specialisation is provided to enhance performance.

Cost Containment

1. Support the identification, development and implementation of cost-effective processes to increase efficiency and reduce cost drivers related to area of specialisation.
2. Continuously review cost / benefit and Return on Investment within area of specialisation.
3. Engage with providers and pre-authorisation agents to build informed and supportive mutual relationships.
4. Maintain a high level of impact on other departments to support improved delivery.
5. Continually increase understanding of client and stakeholder needs, satisfaction, and service delivery.

Knowledge Management

1. Assess all high risk or high cost medical procedures to ensure appropriate authorisation and claiming is facilitated.
2. Provide clinical training / support to identified stakeholders.
3. Provide medical advisory services to relevant parties.
4. Ensure that adequate knowledge regarding specialisation is shared as required and maintained within the research library.

Network Key Relationships

1. Engage with and provide support to the established network of internal and external expert resources and partners.

Specialist Support to Projects

1. Provide specialist expertise and ensure best practice related to specialisation is implemented in projects, when required.
2. Conform to project management disciplines when participating in projects.
3. Represent department or project on appropriate committees related to area of specialisation.

Generic Objectives

1. Knowledge Management: Assess all high risk or high cost medical procedures to ensure appropriate authorisation and claiming is facilitated.
2. Provide clinical training / support to identified stakeholders.
3. Provide medical advisory services to relevant parties.
4. Drive Customer Centricity: Engage with providers and pre-authorisation agents to build informed and supportive mutual relationships.

Qualification and Experience

8 years Managed Care experience preferred.

Knowledge and Skills

1. Skills: Analytical skills, Business Writing Skills, Communication Skills, Attention to Accuracy and Detail, Problem solving and decision making skills, Numerical Ability, Customer Focus.
2. Knowledge: Knowledge and application of relevant legislation, Knowledge of device industry, Ability to provide appropriate medical direction and advisory services, Knowledge and application of clinical principles and processes, Knowledge of clinical and funding protocol development, Clinical research and assessment, Knowledge of scheme rules and contractual negotiations.

Personal Attributes

1. Entrepreneurship: Take chances to continuously improve our Customers' experiences.
2. Influence: Engage with Customers and colleagues to advance the organisation's welfare, making work happen.
3. Collaboration: Build work-related network and share knowledge with colleagues.
4. Credibility: Lead with integrity and trust others as you would like to be trusted.
5. Ownership: Make critical decisions based on what's right for AfroCentric and Customers.

The shortlisting process will only start once the application due date has been reached.

The time taken to complete this process will depend on how far you progress and the availability of line managers.

Our Commitment to Transformation

AfroCentric is committed to transformation and embracing diversity. Our Employment Equity plan and targets will be considered as part of the recruitment process. This commitment is what drives us to achieve a diverse workplace with employment equity as a key goal to create an inclusive workforce, representative of the demographics of our society, as well as people with disabilities. Should you not hear from us within a month of applying, consider your application unsuccessful.

Seniority Level

Mid-Senior level

Employment Type

Full-time

Job Function

Other

Industries

Government Administration