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Urgent! Medical Director in Penang or KL Job Opening In Not Specified – Now Hiring Disruptive Doctors

Medical Director in Penang or KL



Job description

We provide managed healthcare services to corporate clients ranging from SMEs to MNCs.

Responsibilities
  • Medical/Regulatory Oversight
    • Serve as Clinical Governance Officer (CGO) for all our 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 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
  • 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 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
Job Requirements
  • Medical Degree from a recognized university (MD or MBBS preferred)
  • Minimum 5 years of relevant experience in TPA or insurance company
  • Willingness to support after-office-hours remotely


Required Skill Profession

Healthcare & Medical



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    Unlock Your Medical Director Potential: Insight & Career Growth Guide


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