Job Description

Introduction

Through our client-facing brands Momentum Group, with Multiply (wellness and rewards programme), and our other specialist brands, including Guardrisk and Eris Property Group, the group enables business and people from all walks of life to achieve their financial goals and life aspirations. We help people grow their savings, protect what matters to them and invest for the future. We help companies and organisations care for and reward their employees and members.

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.
MBChB or M Fam Med qualification.
Registered with HPCSA as a Medical Practitioner.
Medical advisory knowledge 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.