Medical Director (KL / Penang)

( Medical / Regulatory Oversight - Serve as Clinical Governance Officer (CGO) for all IHP 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.

Clinical Support - Review Patient Information Leaflets (PIL) - Perform regular medication reviews and sign off for VIP, ensuring safe and effective treatment plans

Claims, LOG and Pre-Authorization - Act as the final medical escalation point for claims, LOG, and pre-authorization within IHP - 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

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 IHP’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 (Apply now at #J-18808-Ljbffr