Medical Advisor at Kaelo

Randburg, Gauteng, South Africa -

Full Time

Start Date

Immediate

Expiry Date

13 Apr, 26

Salary

0.0

Posted On

13 Jan, 26

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Medical Degree, Organisational Skills, Communication Skills, Negotiation Skills, Strategic Planning Skills, Clinical Experience, Interpersonal Skills, Evidence Based Medicine, Healthcare Regulations, Risk Management, Patient Care, Clinical Protocols, Decision Making, Teamwork, Healthcare Industry Knowledge, Clinical Input

Industry

Insurance

Description

Company Description Kaelo provides essential healthcare solutions ensuring the physical and psychosocial wellbeing of all South Africans towards lasting social change. Kaelo meets the Healthcare needs of Corporate and Retail clients across South Africa – products offerings include Medical Insurance, Medical Aid, Gap Insurance, Kaelo Money and employee assistance programmes. Job Description Medical Advisors are responsible for ensuring that the Scheme Administrator and Managed Healthcare Organisation adheres to clinical and safety standards. Medical Advisors are expected to engage with the Scheme Administrator, Managed Healthcare Organisation and treating healthcare professionals to ensure the highest quality of evidence based medical care is delivered to patients. They are expected to carry out their duties with patience and confidence. Responsibilities Ensuring that patients receive the highest standard of medical care. Encourage a high standard of performance from clinical staff. Ensuring that all healthcare regulations and safety standards are met. Keeping staff updated on new healthcare regulations. Ensuring appropriate risk management without compromising quality of care. Liaising between administration and medical staff. Participate in decision making on the Clinical Review Committee. Assist with the review, update, and feedback of clinical queries and escalations. Participate and review CMS circular for clinical input. Participate in annual CMS Accreditation submissions. Annual review of all clinical protocols to ensure they are updated. Annual review of all formularies. Responsible for liaising with treating providers for admission updates, treatment plans, discharge or referral. Analyse healthcare spend and make recommendations for enhancements and or changes. Reporting to the Health Executive. Key Outcomes Ensure delivery of appropriate cost efficient care without compromising quality of care. Ensure that, as a Managed Care Organisation, Prime Cure complies with all regulations by the respective governing bodies including Council for Medical Schemes. Provide clinical input into the appropriate care of patients. Support Clinical Staff Supervise the clinical team including non-clinical staff to ensure that proper procedures are being followed and that evidence based medicine is being put into practice. Develop and Maintain Clinical Policies, Procedures and Protocols Develop and maintain Clinical Protocols and SOPs. Regular review of medication formularies. Regular review of Maternity program Regular review of HIV program. Review Patient Complaints Review patient complaints and concerns raised through all channels in the business. Review patient surveys, and adjust policies as necessary. Qualifications REQUIRED Medical Degree Valid registration with the relevant professional body – HPCSA. Good Organisational Skills Excellent Written and Verbal communication skills Exceptional interpersonal skills PMB or Medical Scheme Administration PREFERRED Master of Health Administration (MHA) Master of Business Administration (MBA) WORK EXPERIENCE: 4+ years Clinical Experience Physicians with a strong understanding of medical procedures, equipment, and terminology. Additional Information REQUIRED Decision Making Skills Organisational Skills Communication Skills Negotiation Skills Strategic Planning Skills Ability to work well within a team Ability to work under stress and tight deadlines PREFERRED Knowledge of the Healthcare Industry

Responsibilities

Medical Advisors ensure adherence to clinical and safety standards within the healthcare organization. They engage with various stakeholders to deliver high-quality evidence-based medical care to patients.