Managed Care Medical Officer at DEDA Hospital

Job Objective

As a Managed Care Medical Officer, you will play a pivotal role in overseeing and optimizing healthcare delivery within the managed care unit. You will collaborate with various stakeholders to ensure the effective utilization of resources while maintaining high-quality patient care standards. This position requires a combination of clinical expertise, strategic planning, and strong communication skills.

Reports to

Managed care Coordination QA&QC, Finance Director/ Administration

Direct Report

Customer service officers, nurses, doctors, pharmacy, lab, internal control.

Key Responsibilities:

Clinical Oversight:

• Provide medical expertise and guidance to ensure the delivery of evidence-based, high-quality care.
• Review and evaluate medical necessity, appropriateness, and effectiveness of healthcare services and interventions.

Utilization Management:

• Develop and implement utilization management strategies to optimize resource utilization while maintaining quality care.
• Review and approve treatment plans, referrals, and requests for medical services in accordance with established guidelines and policies.

Provider Collaboration:

• Collaborate with healthcare providers, including physicians, specialists, and allied health professionals, to streamline care delivery and enhance patient outcomes.
• Facilitate communication and coordination among providers to ensure continuity of care and effective care transitions.

Data Analysis and Reporting:

• Analyze healthcare data to identify trends, patterns, and opportunities for improvement in care delivery and cost containment.
• Generate reports and metrics to track key performance indicators and outcomes related to managed care initiatives.

Quality Improvement:

• Participate in quality improvement initiatives to enhance patient safety, satisfaction, and clinical outcomes.
• Implement best practices and evidence-based guidelines to drive continuous improvement in healthcare delivery processes.

Compliance and Regulatory Oversight:

• Ensure compliance with regulatory requirements, accreditation standards, and contractual obligations related to managed care operations.
• Monitor and address issues related to documentation, coding, billing, and claims processing.

EDUCATIONAL QUALIFICATION

• MBBS
• Registration with relevant bodies.   

REQUIRED EXPERIENCE

Minimum of 1 year