Registered Medical Doctor Advisor

Registered Medical Doctor Advisor - JohannesburgRegistered Medical Doctor Advisor with Medical Aid Industry experienceAn exciting opportunity for a Medical Doctor Advisor exists in the Clinical Risk Management group.The successful candidate will provide medical expertise on patient management when reviewing hospital admissions, taking Scheme rules and legislation into account and to provide a client focused cost-effective service.The successful candidate will report directly to the Chief Executive Officer.Must be a Qualified Medical Doctor who is registered with Health Professions Council of South Africa (HPCSA).Should have Medical Aid Indemnity Insurance experience which will be an added advantage but not essential .Must have sound knowledge/experience of the Medical Aid Industry, Rules & Regulations, and other related legislation.Sound knowledge of PMB guidelines and Industry knowledge would be an added advantage.Afrikaans language would be an added advantage.Excellent business writing & communication skills with exceptional telephone etiquette.Must have strong organizational awareness in order to anticipate the impact of actions on other groups.Time Management & good administration skills.Effective conflict resolution skills and the ability to work under pressure.Must be a strong team player and results driven.Computer literacy (MS Office).Advise the Managed Healthcare Medical Aid MHC group on clinical matters pertaining to, pre-authorization, case management, benefit management e.g. PMB’s, disease management and pharmaceutical benefit management, non-disclosures etc. in order to ensure clinical appropriateness of benefits.Recommend various internal groups and the Medical Scheme on clinical matters to ensure that the rules of the Scheme has been correctly applied and implemented.Assess individual cases in accordance with that diagnoses and clinical data motivation letter/benefit structure/Rules of the Scheme/clinical knowledge/experience to facilitate clinical appropriateness of benefits.Assist with the development, implementation and maintenance of Clinical protocols and internal processes for the MHC group to ensure consistency in the application of benefits.Facilitate and provide clinical training to the group to ensure the continuous updating of clinical knowledge and skills, as well as medical advancements.Amend appropriate training material as required to ensure the most up to date clinical information is available.Attend meetings, interdepartmental forums, benefit design workshops, third party representatives and the Scheme to provide clinical input and expertise where it may be required.Attend the Medical Advisory Group meetings/ conferences for the adoption of clinical policies and to keep abreast of industry trends, developments and norms.Research scientific clinical data in order to source advancements to keep abreast of industry trends, developments and norms and advise the Scheme on benefit design and reimbursements.Consult with m