JOB DESCRIPTION
Medical Consultant, State Health Agency (SHA), Professional Programme for Health Protection Lucknow, Uttar Pradesh

1. POSITIONS VACANT: Medical Consultant, State Health Agency (SHA), Professional Programme for Health Protection, Lucknow, Uttar Pradesh

2. ORGANIZATION BACKGROUND:
 

MoHFW has set up National Health Authority (NHA) to manage PM-JAY and at the state level it will be implemented by State Health Agencies (SHAs), set up for this purpose. In order to enhance the capacities of the state implementing agencies to manage PM-JAY, MoHFW/NHA in partnership with GIZ, has initiated the ‘Professional Programme for Health Protection’. The Programme will select, train and mentor consultants to be placed in the State Governments and the NHA to support the implementation of PM-JAY.

As part of this Professional Programme it is proposed to hire a consultant who will support the State Health Agency in Uttar Pradesh in claim adjudication processes, review of various guidelines issued by the NHA along with coordination with the SHAs and support in Hospital Network Management. 

Objective of the Assignment:
 

The objective of the assignment is to support the SHA in implementing Pradhan Mantri – Jan Arogya Yojana (PM-JAY).  Consultant shall support the strengthening of existing institutional structures for PM-JAY at the State level.

For more information about NHA, please visit https://pmjay.gov.in/about/nha 
 

3. JOB DESCRIPTION/ RESPONSIBILITIES:

The Medical Consultant (MC) will be responsible for providing support in claim adjudication processes, empanelment of hospitals, medical audit, prevention of frauds and abuse, claims audit etc, along with matters related to the overall management and standardisation of processes, compliance of guidelines etc. Specific roles and responsibilities will include the following:
 

Specific Tasks

(1) Familiar with the PM-JAY processes. To acquire an in-depth understanding of the guidelines of the scheme and role of various stakeholders;
(2) Provide support to the SHA in assessing the processes adopted in the states for empanelment/ de-empanelment of hospitals as per the empanelment / de-empanelment guidelines of PM-JAY;
(3) Provide support in analysis of medical packages, suggesting revisions in the existing medical packages based on the claims being made in the state;
(4) Provide support in preparing evidence-based standard treatment guidelines, also adapting/ adopting the International guidelines available or support in doing systematic reviews in order to prepare the guidelines;
(5) Conduct the audit of claims being made to prevent the occurrence of frauds/ abuse;
(6) Support the SHA in assisting the states in managing and identification of frauds, help the states in devising mechanisms and systems to prevent, detect and control these frauds;
(7) Assist in performing audits of the scheme whenever necessary;
(8) Undertake new initiatives and projects under PM-JAY;
 

Documentation:

(1) Preparation of technical reports, analysis of data, new proposals and assessment reports.

4. QUALIFICATION, SKILLS AND EXPERIENCE:     

Qualifications:

Essential
(1) MBBS or equivalent processes supporting private or government health insurance companies;

Desirable
Post-graduation or higher qualification in the field of Public health, community heath, health management, from a recognized university or institute;

Experience:
(1) Minimum one to five years of experience of working in large-scale government health insurance schemes or sector of health insurance in managing claims, hospital empanelment, medical audit of hospitals, quality of delivery of health services etc.;
(2) Relevant experience in claims adjudication processes supporting private or government health insurance companies;

Skills and Competencies:
(1) Sound knowledge of the health insurance / public health sector;
(2) Analytical skills and strategic thinking;
(3) Demonstrated ability to work in a multi-disciplinary team;
(4) Knowledge of commonly used software packages like MS Word, Excel, Power Point;
(5) Ability to work under pressure and attend to any ad hoc functions as may be required;
(6) Self-driven and able to work with tight deadlines;
(7) Excellent communication and presentation skills, sound comprehension, strong analytical and interpersonal abilities.
(8) Ability to work independently when required;
(9) Excellent oral and written communication skills in English and Hindi.

5. VACANCY DETAILS: One vacancy         

6. COMPENSATION OFFERED:

The offer made to the selected candidate shall be commensurate with qualifications, experience, and salary history.

7. LOCATION: Lucknow, Uttar Pradesh

8. CONTRACT TYPE AND PERIOD:

The successful candidate shall be issued a consultancy contract from the date of joining till February 29, 2024.

9. REFERENCE: MC-SHA-UP

10. CONTACT INFORMATION: 
 

Team SAMS
Strategic Alliance Management Services P Ltd.
1/1B, Choudhary Hetram House, Bharat Nagar
New Friends Colony, New Delhi 110 025
Phone Nos.: 011-41011564/65; 4081 9900 
 

11. LAST DATE FOR APPLICATIONS: 
 

Eligible candidates interested in the position are requested to apply using the link https://recruitment.samshrm.com/Jobs/GIZ by or before September 26, 2023.