Roving Doctor

Duties and Responsibilities:

Managing a group of hospitals to ensure that inpatient customers are receiving optimal healthcare within agreed quality parameters. The Roving Doctor provides medical expertise across multiple sites ensuring high-quality patient care, compliance with medical standards, and support for clinical teams. This role involves regular travel, flexibility, and the ability to work in diverse healthcare settings.

• Consultants and Medical Directors at Providers
• Collaborate with consultants at providers to agree on case management plans.
• Monitor all inpatient cases closely on a daily basis.
• Escalate critical issues to the provider's medical management team as needed.

Insurance Offices and Provider Management:

• Ensure approvals and rejections are mutually agreed upon.
• Verify that invoicing aligns with the terms of the agreement.

Customer Care:

• Maintain communication with inpatients and their families to enhance the company’s image.
• Proactively address and resolve any issues faced by customers or their families at the hospital.

Hospital Admissions:

• Provide accurate and detailed daily updates on all inpatient cases, including justifications for decisions made.

Reporting:

• Submit reports on savings and fraud to Medical Approvals Manager.
• Notify Provider Relations of high-value claim cases.
• Market Practices reporting
• Proactively gather and report insights on provider and competitor practices to the regional team.

Compliance and Ethics:

• Ensure all medical practices align with local healthcare regulations and ethical standards.
• Promote patient safety and confidentiality across all facilities.

Medical Auditing and Oversight:

• Review patient files for accuracy, completeness, and compliance with organizational standards.
• Identify gaps in documentation and recommend corrective actions.
• Support the approvals and claims team in reviewing and validating medical necessity for services

Education:

• Bachelor’s degree in medicine.
• Preferably diploma or masters in a clinical specialty.

Experience:

• 2 years of experience in same roving role or active medical practice.
• Familiarity with health insurance industry practices, policies, and regulations.

Personal Attributes / Skills:

• Strong diagnostic and clinical decision-making skills.
• Excellent communication and interpersonal skills.
• Ability to work independently and adapt to diverse environments.
• Proficiency in electronic medical record (EMR) systems and reporting tools.
• Familiarity with healthcare policies, medical insurance processes, and claims adjudication.
• Willingness to travel frequently and work flexible hours.

Others:

• Excellent Communication and negotiation skills.
• Extensive and updated medical know-how.