Medical Director (KL / Penang)
Hiredly XPuchong, Selangor, Malaysia30+ hari lalu
Penerangan pekerjaanReview Patient Information Leaflets (PIL) Perform regular medication reviews and sign off for VIP, ensuring safe and effective treatment plans 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 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
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
Claims, LOG and Pre-Authorization
Business Development Support
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Director • Puchong, Selangor, Malaysia