Associate Director - Country Health Clinical Governance
Job responsibilities :
Provide any clinical consultation with high cost claim approval from medical perspective
Provide clinical leadership to the clinical teams ensuring that they are kept up to date with changes in medical practice.
Develop and implement a clinical quality strategy, which assures our members that they are receiving high quality and appropriate care.
Ensure that all treatment and care given to our members including admission to hospital is appropriate and in accordance with agreed protocols.
Encourage clinical best practice by providing analytical feedback hospitals, clinics and doctors on clinical practice including procedural costs, length of stays and outcomes.
Ensure that all hospitals and clinics in our network meet our standards of care and take necessary action when the care given is below standard.
Ensure that any new clinical procedures, drugs or technology are appropriate and safe for our customers
To review and manage the treatment of high claiming members to ensure that their treatment is appropriate
Assist with the development of health information for our members.
Network with both insurance and hospital medical directors to develop industry wide policies and procedures where appropriate eg. surgical schedule.
Participate in the management team meetings and contribute to the overall development and improvement of the business.
Participate in Company Project as Medical Department
Attend the pool insurance meeting as schedule
Attend claim and clinical committee as team member
Qualifications
Full-Time
15 active jobs
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