Medical Advisor

Competent Candidates; Pretoria; On-site; ZAR 600,000 - 800,000; Full time

Job summary

A leading healthcare services provider is looking for a Medical Advisor to join their team in Pretoria. This full-time role requires an MBChB degree, HPCSA registration, and 3-5 years of experience in the healthcare field. The Medical Advisor will offer clinical support, ensure compliance with medical guidelines, and lead evidence-based treatment decisions.

Qualifications

• 3-5 years' experience in medical scheme or managed healthcare environment.
• Valid HPCSA registration required.
• In-depth knowledge of the Medical Schemes Act and health industry metrics.

Responsibilities

• Provide expert clinical input across various healthcare management areas.
• Evaluate clinical evidence and make funding decisions.
• Communicate effectively with stakeholders.

Skills

Communication

Decision Making

Conflict Resolution

Customer Focus

Collaboration

Education

MBChB degree

Additional postgraduate certifications

Tools

Microsoft Office

Healthcare systems

Job description

Exciting Opportunity : Medical AdvisorLocation : On-site Contract Type : Full-timeOur client, a leading healthcare services provider, is seeking a qualified and experienced Medical Advisor to join their dynamic team.

This is a key clinical and advisory role that supports accredited managed healthcare services by ensuring compliance with the Medical Schemes Act, Council for Medical Schemes (CMS) guidelines, legislative requirements, and funding protocols.Key Purpose of the RoleThe Medical Advisor will make clinically sound and cost-effective funding decisions on complex medical cases, guided by evidence-based medicine and treatment protocols.

The ideal candidate will act as a trusted advisor - collaborating with internal clinical teams and external healthcare providers - ensuring quality care delivery and adherence to scheme rules.Minimum Requirements

MBChB degreeValid HPCSA registration3–5 years' experience in a medical scheme or managed healthcare environmentAdditional postgraduate certifications (advantageous)

Key Responsibilities

Provide expert clinical input across pre-authorisation, hospital case management, audits, chronic disease and oncology management, pharmaceutical benefits, and spinal programme servicesEvaluate clinical evidence and high cost / risk cases with clear, timely funding decisionsCommunicate decisions effectively with stakeholders (providers, members, brokers)Support the Clinical Committee and executive leadership with escalated casesContribute to protocol and treatment basket developmentParticipate in clinical forums and build strong provider relationshipsStay informed on industry coding (ICD10, CPT, RPL), CMS publications, and claims structuresIdentify healthcare trends, advise on innovation, and support operational improvementsAssist in resolving coding, billing, and claims-related issuesShare clinical guidance across internal business units

In-depth knowledge of the Medical Schemes Act, PMBs, and health industry metricsExperience in clinical practice (preferably private hospital / clinic setting)Strong verbal and written communication skillsHigh level of accountability and decision-making abilityCollaborative, adaptable, and tech-savvyCustomer-focused with strong business insightSkilled in conflict resolution and influencing stakeholdersProficient in Microsoft Office and healthcare systems

Application RequirementsTo apply, please submit the following :

A compelling cover letter outlining your motivation and the value you bringCertified copy of your HPCSA registrationAbridged Curriculum Vitae (CV)

If you're passionate about advancing evidence-based healthcare and influencing clinical decisions at a systemic level, we invite you to apply for this impactful role.Apply now and help shape the future of managed healthcare.