Medical Advisor

AfroCentric Group; Roodepoort; Presencial; ZAR 900.000 - 1.200.000; Jornada completa

Descripción de la vacante

AfroCentric Group is seeking an experienced medical professional to ensure protection against over-utilisation and improper claiming within our schemes. The role focuses on clinical inputs, review of complex cases, and collaboration with providers to uphold funding protocols.

You will assess high-cost procedures, provide advisory support, and drive improvements in efficiency and quality while engaging with healthcare stakeholders across the network.

Formación

• MBChB degree with registration is required.
• 6–8 years managed care experience is preferred.
• Excellent written and verbal communication is essential.
• Ability to engage with healthcare providers and stakeholders.

Responsabilidades

• Provide clinical inputs on ex-gratia funding requests and resolve clinical queries.
• Review and resolve assessments using clinical judgment.
• Propose practical solutions to improve efficiency, compliance and quality.
• Identify problems and develop actionable solutions for leaders.
• Ensure day-to-day operational support within the area of specialisation.
• Assess high-cost procedures for proper authorisation and claiming.
• Provide clinical training and advisory support to stakeholders.
• Engage with providers and pre-authorisation agents to build relationships.

Conocimientos

Peer-to-Peer comms

Clinical decision making

Stakeholder engagement

Risk management

Educación

MBChB degree

Descripción del empleo

Position Purpose

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

Duties & Responsibilities

Key responsibilities:

• 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.
• Implement practical solutions that use the specialist and departmental systems and processes
• Provide specialist input and recommendations to improve the efficiency, compliance and quality objectives related to the area of specialisation.
• Identify problems and develop and propose solutions to present to appropriate leader or stakeholders.
• Ensure day to day operational support required from area of specialisation is provided to enhance performance.
• Assess all high risk or high-cost medical procedures to ensure appropriate authorisation and claiming is facilitated.
• Provide clinical training / support to identified stakeholders.
• Provide medical advisory services to relevant parties.
• Engage with providers and pre‑authorisation agents to build informed and supportive mutual relationships.

Desired Experience & Qualification

Experience

• 6 - 8 years Managed Care experience preferred.
• Excellent communication skills, both written and verbal to assist with "Peer to Peer" engagements with Healthcare Providers to defend our funding protocols and discuss patient treatment plans.
• Risk Management

Qualification

• MBChB medical degree

Package & Remuneration

Market Related