Select how often (in days) to receive an alert:Medical Advisor - Talent PoolBusiness Unit: Discovery HealthFunction: Medical DoctorDate: 15 Jan 2025Clinical Benefit Advisory TeamMedical AdvisorAbout DiscoveryDiscovery'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 TeamThe 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.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 metParticipating in key clinical forums internally and externallyDaily Clinical Review – Preparing of cases, case presentation, loading member remarks and clinical exceptions, arranging second opinions/external expert opinion and follow upCommunication of funding decisions to the relevant partiesKeeping abreast with legislative and industry changes and how it affects your business unitKeeping updated with the latest clinical thinking and attending CPD eventsIdentification of new trends in Medical Industry, and engagement with relevant clinical stakeholders:Constant interaction and relationship building with external health care providersMaintenance of database of funding decisions madeSupport to Junior Staff and other Medical AdvisorsKnowledge of Claims, coding and assisting in getting payment resolutionsIdentify operational gaps and initiate improvement strategiesClear knowledge of evidence based medicine and the application thereofReview of clinical evidence on a case by case basisLiaison with various business group TWGsKnowledge 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)Education and Experience:The following requirements are essential:MatricQualified Medical DoctorFull and Current HPCSA registration - Independent PracticeMinimum of two years experience in a Private hospital or clinicThe following requirements will be advantageous:Previous Medical Advisor or managed healthcare experienceKnowledge of DH SOP's and Process experience (internal only)Provider payment arrangements (internal Only)Clinical coding knowledge of ICD-10 and/or CCSAPersonal Attributes or Competency ProfileThe Discovery PersonValues DrivenLearns on the FlyResilientInstils TrustPeople SavvyDrives ResultsEMPLOYMENT EQUITYThe 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.
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