Job Description

Closing Date 2025/08/29
Reference Number MMH250812-6
Job Title Medical Advisor X2
Position Type Permanent
Role Family Medical
Cluster Momentum Health
Remote Opportunity Some of the time
Location - Country South Africa
Location - Province Western Cape
Location - Town / City Bellville/Centurion
Introduction
Momentum Health Solutions, an entity of Momentum Metropolitan Holdings delivers sustainable, integrated health solutions that meet the needs of clients in the different segments and maximise lifetime client value. We build and maintain a culture of innovation and create value through unique insights of how to achieve specific outcomes by using a defined set of Health capabilities.
Disclaimer As an applicant, please verify the legitimacy of this job advert on our company career page.
Role Purpose Managing the delivery of clinical input across the business unit. Overseeing the effective application of evidence based medicine and risk management principles.
Requirements

• Matric. (Essential)
• MBChB or M Fam Med qualification. (Essential)
• Registered with HPCSA as a Medical Practitioner. (Essential)
• In depth knowledge of clinical coding and tariff codes used across disciplines is essential.
• Understanding of PMB regulations and entitlements.
• Knowledge of the Medical Scheme Act and other relative legislation for the industry.
• Previous Medical Advisory experience in a healthcare administrator/managed care entity will be an advantage.

Duties & Responsibilities
PROCESS

• Medical Advisory work, as directed by Health Risk Management and claims adjudication teams.
• Managing the delivery of clinical input across the relevant business units.
• 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 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.

CLIENT

• Build and maintain relationships with clients and stakeholders that promote functional synergy and bilateral solutions, allowing the team to provide exceptional client service.
• Contribute to sustaining a competitive edge through external networking and benchmarking and representation on related forums.
• Engage with key internal and external stakeholders to identify changing client needs and make recommendations to align service offering with client needs.
• Promote a client service-excellence culture.
• Manage the introduction of new channels for client interaction in order to improve client services against service expectations.

PEOPLE

• Be a member of and make positive contributions to Professional Bodies and Stakeholder Groups.
• Create a positive work climate and culture to energise employees, give meaning to work, minimise work disruption and maximise employee productivity.
• Demonstrate exemplary leadership behaviour, through personal involvement, commitment and dedication in support of organisational values.
• Drive a culture that guides and directs best practice, fostering an environment of continuous learning, improvement and cohesiveness.
• Enable a learning and growth culture whereby information regarding successes, issues, trends and ideas are actively shared between team members.
• Effectively contribute to performance within the team in order to ensure business objectives are achieved.
• Encourage innovation, change agility and collaboration within the team

Competencies

• Examining Information: Analyses and processes information; asks probing questions; strives to find solutions to problems.
• Interpreting Data: Interprets data rationally by quantifying issues; applies technology as a means to evaluating data; evaluates information objectively.
• Providing Insights: Is focused on continuously improving things; provides insights by identifying key issues; makes intuitive judgments.
• Generating Ideas: Is creative in producing ideas; assumes an original approach when generating ideas; adopts radical solutions.
• Making Decisions: Is determined and decides on actions; willingly assumes responsibility; is definitive and stands by own decisions.
• Checking Things: Is meticulous in finding errors; ensures accuracy by being thorough and checking details; produces high quality work by being detailed.
• Managing Tasks: Manages tasks by being organised and methodical; plans activities systematically; sets priorities for tasks.
• Taking Action: Takes action to make things happen; uses initiative to start things up; shows drive and invests personal energy.

Policy
We are committed to Employment Equity, diversity and inclusion when recruiting internally and externally. All appointments are made in alignment to our Employment Equity goals and we encourage people with disabilities to apply.