Associate Director - Country Health Clinical Governance

Job responsibilities :

• Clinical Leadership and High Cost Claim Consultation

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.

• Clinical Quality

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

• Clinical Advice and Consultation

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

• Clinical Governance scheme

Attend the pool insurance meeting as schedule

Attend claim and clinical committee as team member

Qualifications

• Bachelor’s or Master’s Degree in Nursing
• At Least 5-10 yrs of experience in Nurse in hospital and insurance industry experience will be advantage