Assistant Medical Director

Assistant Medical Director (HMO)

The Assistant Medical Director supports the Medical Director in overseeing clinical operations, ensuring quality healthcare delivery, and maintaining compliance with healthcare regulations. This role plays a key part in provider management, utilization review, and improving member care within the HMO network.

Key Responsibilities:

• Assist the Medical Director in planning, organizing, and directing medical services of the HMO
• Conduct utilization review and evaluate medical necessity of treatments, procedures, and admissions
• Ensure compliance with Philippine healthcare regulations, HMO policies, and accreditation standards (e.g., Philippine Health Insurance Corporation guidelines)
• Review and approve or recommend approval/denial of claims, LOAs (Letters of Authorization), and reimbursements
• Monitor healthcare provider performance, quality of care, and patient outcomes
• Support provider network development, credentialing, and accreditation processes
• Handle complex medical cases, second opinions, and dispute resolutions
• Assist in developing clinical guidelines, policies, and standard operating procedures
• Participate in audits, risk management, and quality assurance programs
• Collaborate with internal departments (claims, customer service, operations) to improve service delivery
• Provide medical expertise for corporate decisions, case management, and cost containment strategies

Qualifications:

• Doctor of Medicine (MD) with a valid PRC license
• Preferably with specialization (e.g., Internal Medicine, Family Medicine, or Public Health)
• At least 3–5 years clinical experience, with exposure to HMO/insurance setting preferred
• Experience in utilization review, case management, or healthcare administration is an advantage
• Knowledge of healthcare regulations and HMO operations in the Philippines
• Strong analytical, decision-making, and leadership skills

Skills & Competencies:

• Clinical judgment and critical thinking
• Strong communication and interpersonal skills
• Leadership and team management
• Attention to detail and documentation accuracy
• Ability to handle confidential information
• Problem-solving and conflict resolution

Reporting Line:

• Reports directly to the Medical Director