Medical Advisor

Discovery Limited; Sandton; On-site; ZAR 900,000 - 1,300,000; Full time

Job summary

Discovery Limited seeks a Medical Advisor for our Talent Pool to support funding decisions for clinically complex cases, aligning with evidence based medicine and member outcomes. The role is based in Sandton, within CBAT, liaising with Medical Review and other teams.

The ideal candidate is a qualified Medical Doctor with HPCSA registration, strong PMB knowledge, and at least two years in a private hospital or clinic.

Qualifications

• Matric (secondary schooling)
• Qualified Medical Doctor with full HPCSA registration
• Minimum two years' experience in a private hospital or clinic
• Proficient in Microsoft Office, especially Excel, and able to use basic data tools

Responsibilities

• Provide clinical support to the Medical Review team and CBAT colleagues.
• Ensure workflow pools and TWT (time-to-workflow targets) are met.
• Participate in internal and external clinical forums.
• Daily clinical review: case preparation, presentation, and arranging second opinions.
• Communicate funding decisions to relevant stakeholders.
• Stay updated on legislation, industry changes, and CPD events.

Skills

Managed Care Environment

PMB knowledge

English communication

MS Office / Excel

Education

Matric

Qualified Medical Doctor

HPCSA registration

2 years private hospital/clinic experience

Job description

Medical Advisor - Talent Pool

Discovery’s core purpose is to make people healthier and to enhance and protect their lives. We seek out and invest in exceptional individuals who understand and support our core purpose, and whose own values align with those of Discovery. Our fast-paced and dynamic environment enables smart, self-driven people to be their best. As global thought leaders, Discovery is passionate about innovating in order to not only achieve financial success, but to ignite positive and meaningful change within our society.

About 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.

Key Outputs

The successful applicant will be responsible for but not limited to the following job functions:

• 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, as well as other business areas.
• Ensuring the workflow pools and TWT are met
• Participating in key clinical forums internally and externally
• Daily Clinical Review – Preparing of cases, case presentation, loading member remarks and clinical exceptions, arranging second opinions/external expert opinion and follow up
• Communication of funding decisions to the relevant parties
• Keeping abreast with legislative and industry changes and how it affects your business unit
• Keeping updated with the latest clinical thinking and attending CPD events

Identification of new trends in Medical Industry, and engagement with relevant clinical stakeholders

• Constant interaction and relationship building with external health care providers
• Maintenance of database of funding decisions made
• Support to Junior Staff and other Medical Advisors
• Knowledge of Claims, coding and assisting in getting payment resolutions
• Identify operational gaps and initiate improvement strategies
• Clear knowledge of evidence based medicine and the application thereof
• Review of clinical evidence on a case by case basis
• Liaison 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)

Competencies

Role Specific Behaviours

• Ensures accountability.
• Action oriented
• Manages ambiguity.
• Attracts top talent.
• Business insight
• Collaborates
• Communicates effectively.
• Manages complexity.
• Manages conflict.
• Courage
• Customer focus
• Decision quality
• Develops talent
• Values differences
• Directs work.
• Drives engagement
• Financial acumen
• Global perspective
• Cultivates innovation.
• Interpersonal savvy
• Builds networks.
• Nimble learning
• Organizational savvy
• Persuades
• Plans and aligns.
• Being resilient
• Resourcefulness
• Drives results
• Demonstrates self-awareness.
• Self-development
• Situational adaptability
• Balances stakeholders
• Strategic mindset
• Builds effective teams.
• Tech savvy
• Instils trust.
• Drives vision and purpose
• Optimizes work processes

Education And Experience

• 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 or Competency Profile

The Discovery Person

• Values Driven
• Optimistic
• Learns on the Fly
• Resilient
• Instils Trust
• People Savvy
• Drives Results
• Problem Solver

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.