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 ProvidersCollaborate 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 reportingProactively 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 servicesEducation: 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.