Hiredly X

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Trustworthy

Medical/Regulatory Oversight
- Serve as Clinical Governance Officer (CGO) for all clinics
- Lead audit preparation and execution to ensure regulatory compliance
- Act as the ordering doctor for laboratory and imaging tests, including prompt responses to critical results
- Address general medical regulations queries from internal and external stakeholders
- Lead initiatives to manage and reduce the cost of medical claims through clinical review, provider negotiation, and strategic interventions.
- Conduct and oversee claims audits, identifying patterns of overutilization or fraud, waste, and abuse (FWA).
- Monitor provider performance and billing behavior to identify and mitigate fraud, waste, and abuse (FWA); initiate corrective actions where necessary.
- Develop internal cost containment SOPs and workflows in collaboration with operational teams to streamline claims processing and medical adjudication.
- Act as the primary client-facing representative for all matters related to medical cost containment.
- Prepare regular reports and presentations for leadership and clients, highlighting key cost drivers, trends, and opportunities for optimization.
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Clinical Support
- Review Patient Information Leaflets (PIL)
- Perform regular medication reviews and sign off for VIP, ensuring safe and effective treatment plans
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Claims, LOG and Pre-Authorization
- Act as the final medical escalation point for claims, LOG, and pre-authorization within the company
- Develop and refine general guidelines and definitions for medical reimbursable claims
- Provide strategic support to the Claims and LOG teams in developing and enhancing STP workflows and overall process improvements
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Business Development Support
- Participate in presentations and stakeholder engagement as a clinical representative
- Collaborate on workflow reviews to align clinical operations with BD initiatives
- Contribute to the ongoing refinement of company's data analytics, offering client insights and actionable strategies.
- Provide KIV support for on-site rollout of services
- Participation in initiative-based projects as required, including clinical input and representation in BD-related presentations and discussions
- Chronic disease management program- Involvement in design, execution, and evaluation
- LPA program- Support for program rollout and medical compliance

This job is for a Medical Director in KL/Penang, overseeing clinics and ensuring they follow healthcare regulations. You might like this job because you’ll lead initiatives to cut medical costs, work with teams on patient care, and help shape healthcare strategies.

Governance

Clinical Governance

Clinical Practices

Clinical Supervision

Medical Assistance

Medical/Regulatory Oversight
- Serve as Clinical Governance Officer (CGO) for all clinics
- Lead audit preparation and execution to ensure regulatory compliance
- Act as the ordering doctor for laboratory and imaging tests, including prompt responses to critical results
- Address general medical regulations queries from internal and external stakeholders
- Lead initiatives to manage and reduce the cost of medical claims through clinical review, provider negotiation, and strategic intervention...

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