Medical Advisor

AfroCentric Group; Wes-Kaap; On-site; ZAR 30,000 - 60,000; Full time

Job summary

An established industry player is seeking a clinical expert to ensure the protection of scheme funds against over-utilization. This role focuses on providing clinical insights, engaging with stakeholders, and implementing cost-effective processes. The ideal candidate will possess a strong background in managed care, with a commitment to continuous improvement and knowledge sharing. Join a forward-thinking organization dedicated to transformation and diversity, where your expertise will significantly impact service delivery and operational efficiency.

Qualifications

• 8 years of Managed Care experience preferred.
• MBChB degree required.

Responsibilities

• Provide clinical inputs on ex-gratia funding requests.
• Engage with providers to build supportive relationships.
• Assess high-risk medical procedures for authorization.

Skills

Managed Care

Clinical Decision Making

Cost-Benefit Analysis

Stakeholder Engagement

Clinical Training

Education

MBChB Degree

Job description

What will you do?

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.

Accountabilities

Generic Objectives

Continuous improvement:

• Provide clinical inputs on ex-gratia funding requests.
• Open, review, and resolve all clinical queries and assessments by providing a clinical decision or requesting additional information where required.
• Implement practical solutions using specialist and departmental systems and processes.
• Provide specialist input and recommendations to improve efficiency, compliance, and quality objectives related to the area of specialization.
• Identify problems and develop solutions to present to relevant leaders or stakeholders.
• Ensure operational support from the area of specialization is provided to enhance performance.

Cost containment:

• Support the development and implementation of cost-effective processes to increase efficiency and reduce cost drivers.
• Review cost/benefit and Return on Investment within the area of specialization regularly.

Drive customer-centricity:

• Engage with providers and pre-authorisation agents to build informed and supportive relationships.
• Maintain a high level of impact on other departments to support improved service delivery.
• Increase understanding of client and stakeholder needs, satisfaction, and service delivery continually.

Knowledge management:

• Assess high-risk or high-cost medical procedures to ensure appropriate authorization and claims processing.
• Provide clinical training and support to relevant stakeholders.
• Offer medical advisory services to relevant parties.
• Ensure knowledge regarding specialization is shared and maintained within the research library.
• Provide advice and training as needed.
• Maintain, develop, and implement specialist knowledge in daily operations.

Maintain expertise level:

• Be a member of relevant professional bodies.
• Meet CPD or similar accreditation requirements annually to maintain specialist accreditation.

Network key relationships:

• Engage with and support internal and external expert resources and partners.

Specialist support to projects:

• Provide expertise and ensure best practices related to specialization are implemented in projects.
• Conform to project management disciplines when participating in projects.
• Represent the department or project on relevant committees.

Qualification and Experience

• 8 years Managed Care experience preferred.
• MBChB degree required.

Turnaround Time

The shortlisting process will commence once the application due date has passed. The duration depends on your 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 during recruitment. We aim to create a diverse, inclusive workforce that reflects societal demographics and includes people with disabilities.

Note: If you do not hear from us within a month of applying, consider your application unsuccessful.