Managed Care Medical Advisor

The Managed Care Medical Advisor is responsible for providing clinical leadership, medical oversight, and evidence-based guidance in support of managed care services de. The incumbent will ensure that funding decisions, clinical policies, care management interventions, and healthcare risk management activities are clinically appropriate, financially sustainable, and aligned with industry best practice and Namibian healthcare regulations. Key Responsibilities: Clinical Governance and Advisory

• Provide clinical oversight and guidance on all managed care activities performed on behalf of company.
• Review and support the development of clinical funding policies, treatment protocols, and benefit management rules.
• Ensure funding decisions are evidence-based, clinically appropriate, and aligned with scheme rules and applicable legislation.
• Provide expert medical input on complex clinical cases and funding exceptions.

Managed Care and Healthcare Risk Management

• Support the implementation and enhancement of managed care interventions aimed at improving quality of care and cost-effectiveness.
• Analyse healthcare utilisation trends and identify opportunities to improve clinical outcomes and reduce healthcare risk.
• Assist in the development and monitoring of disease management, case management, and chronic care programmes.
• Evaluate emerging healthcare technologies, medicines, and treatment modalities for potential inclusion in funding protocols.

Clinical Research and Policy Development

• Review local and international clinical guidelines and best-practice standards.
• Conduct clinical research and literature reviews to support policy development and funding decisions.
• Recommend improvements to managed care programmes based on evidence, utilisation data, and industry developments.

Stakeholder Engagement

• Provide clinical advice and support to company management, trustees, committees, and other stakeholders.
• Participate in clinical and healthcare risk management committees as required.
• Build and maintain effective relationships with healthcare providers, specialists, hospitals, and industry stakeholders.
• Prepare and present clinical reports, recommendations, and presentations when required.

Operational Support

• • Provide clinical mentorship and support to members of the managed care team.
  • Ensure timely, accurate, and professional completion of all assigned responsibilities.
  • Contribute to strategic managed care initiatives and special projects as required.

• Bachelor of Medicine and Bachelor of Surgery (MBChB) or equivalent medical degree.
• Current registration with the Health Professions Councils of Namibia (HPCNA) or eligibility for registration.
• Minimum of five (5) years' post-community service clinical experience.
• Minimum of three (3) years' experience within a managed healthcare, medical scheme, health insurance, or healthcare funding environment.
• Experience in clinical risk management, utilisation management, case management, disease management, or healthcare funding will be advantageous.
• Experience working with medical aid funds or healthcare payers in Namibia or Southern Africa will be beneficial.

Competencies:

• Strong clinical knowledge and medical decision-making ability.
• Understanding of managed healthcare principles and healthcare funding models.
• Strong analytical and problem-solving skills.
• Excellent report writing and presentation skills.
• Ability to interpret clinical and healthcare utilisation data.
• Strong stakeholder management and relationship-building capability.
• High level of professionalism, integrity, and confidentiality.
• Ability to work independently and within multidisciplinary teams.

  Closing Date: 19 June 2026