Medical Advisor at Momentum Metropolitan Holdings Limited

Requirements

• Matric
• MBChB or M Fam Med qualification
• Registered with HPCSA as a Medical Practitioner
• Medical advisory knowledge will be an advantage
• Previous medical advisory experience will be an advantage.

Duties & Responsibilities

• Medical Advisory work, as directed by the Health Risk Management and Client Execution.
• Managing the delivery of clinical input across the business unit.
• Overseeing the effective application of the Health Risk Management clinical policies and protocols across the business unit.
• Training of case managers, pharmacists and/or pharmacist assistants in case forums.
• Attendance of Medical Advisors meetings.
• Relevant work to be done with reference to medical scheme rules and within the parameters of relevant coding rules and Evidence Based Medicine.
• Supporting the development of guidelines and protocols for the Health Risk Management according to the standards prescribed by the Head of Clinical Policy.
• Review of the pathology, radiology and Prescribed Minimum Benefit (PMB) claims and maintenance of the tariff files in conjunction with the coding team.
• Provision of clinical input and presentation of ex-gratia cases on a monthly basis at client Clinical forums.
• Generation and analysis of product specific reports on a monthly basis.
• Management of the benefit design requirements for identified schemes as it relates to clinical input.
• Build and maintain relationships with clients and stakeholders that promote cross delivery practice solutions.
• Contribute to sustaining a competitive edge through external networking and benchmarking and representation on related forums.

Competencies

• Interpreting Data
• Examining Information
• Managing Tasks
• Making Decisions
• Providing Insights
• Taking Action