Job Description

Company DescriptionAbout Kaelo
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.Medical Advisor 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.Medical Advisor 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 the Clinical Advisor with review, update, and feedback of clinical queries and escalations.
• Participate and review CMS circular for clinical input.
• Participate in annual CMS Accreditation submissions.
• Bi-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 Head of Clinical Operations.

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.

QualificationsREQUIREDMedical DegreeValid registration with the relevant professional body - HPCSA.Good Organisational SkillsExcellent Written and Verbal communication skillsExceptional interpersonal skillsPMB or Medical Scheme AdministrationPREFERREDMaster of Health Administration (MHA)Master of Business Administration (MBA)WORK EXPERIENCE:4+ years Clinical ExperiencePhysicians with a strong understanding of medical procedures, equipment, and terminology.TECHNICAL SKILLS OR KNOWLEDGEREQUIREDDecision Making SkillsOrganisational SkillsCommunication SkillsNegotiation SkillsStrategic Planning SkillsAbility to work well within a teamAbility to work under stress and tight deadlinesPREFERREDKnowledge of the Healthcare IndustryAdditional Information

• Accountability
• Action orientated
• Collaborative
• Communication
• Business writing skills
• Manage complexity
• Problem solving skills
• Decision thinking
• Encourages engagement
• Resilient and adaptive
• Resourceful
• Demonstrates self-awareness
• Purpose driven
• Significance and values orientated

Kaelo