Medical Advisor

SUMMARY:
Make clinically sound and cost-effective funding decisions on complex medical cases.

POSITION INFO:

Exciting Opportunity: Medical Advisor

Location: On-site

Contract Type: Full-time

Our client, a leading healthcare services provider, is seeking a qualified and experienced Medical Advisor to join their dynamic team. This is a key clinical and advisory role that supports accredited managed healthcare services by ensuring compliance with the Medical Schemes Act, Council for Medical Schemes (CMS) guidelines, legislative requirements, and funding protocols.

Key Purpose of the Role

The Medical Advisor will make clinically sound and cost-effective funding decisions on complex medical cases, guided by evidence-based medicine and treatment protocols. The ideal candidate will act as a trusted advisor - collaborating with internal clinical teams and external healthcare providers - ensuring quality care delivery and adherence to scheme rules.

Minimum Requirements

• MBChB degree
• Valid HPCSA registration
• 3–5 years’ experience in a medical scheme or managed healthcare environment
• Additional postgraduate certifications (advantageous)

Key Responsibilities

• Provide expert clinical input across pre-authorisation, hospital case management, audits, chronic disease and oncology management, pharmaceutical benefits, and spinal programme services
• Evaluate clinical evidence and high cost/risk cases with clear, timely funding decisions
• Communicate decisions effectively with stakeholders (providers, members, brokers)
• Support the Clinical Committee and executive leadership with escalated cases
• Contribute to protocol and treatment basket development
• Participate in clinical forums and build strong provider relationships
• Stay informed on industry coding (ICD10, CPT, RPL), CMS publications, and claims structures
• Identify healthcare trends, advise on innovation, and support operational improvements
• Assist in resolving coding, billing, and claims-related issues
• Share clinical guidance across internal business units

Key Skills & Competencies

• In-depth knowledge of the Medical Schemes Act, PMBs, and health industry metrics
• Experience in clinical practice (preferably private hospital/clinic setting)
• Strong verbal and written communication skills
• High level of accountability and decision-making ability
• Collaborative, adaptable, and tech-savvy
• Customer-focused with strong business insight
• Skilled in conflict resolution and influencing stakeholders
• Proficient in Microsoft Office and healthcare systems

Application Requirements

To apply, please submit the following:

• A compelling cover letter outlining your motivation and the value you bring
• Certified copy of your HPCSA registration
• Abridged Curriculum Vitae (CV)

If you're passionate about advancing evidence-based healthcare and influencing clinical decisions at a systemic level, we invite you to apply for this impactful role.

Apply now and help shape the future of managed healthcare.