Medical Advisor - Managed Care & Risk Compliance

AfroCentric Group; Roodepoort; On-site; ZAR 900,000 - 1,200,000; Full time

Job summary

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.

Qualifications

• 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.

Responsibilities

• 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.

Skills

Peer-to-Peer comms

Clinical decision making

Stakeholder engagement

Risk management

Education

MBChB degree

Job description

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.