Conduct thorough reviews of medical records and provide expert opinions on claimants' conditions. Deliver clear written reports within five days and respond to clinical inquiries to support claims management.

• Develops ongoing professional relationships with key decision makers in organized health systems to ensure access to medical and scientific information on the full product portfolio and areas of therapeutic interest • Develops strategic account plans in partnership with the Integrated Account Management (IAM) Account Executive teams and executes medical activities in alignment with agreed plan • Serves as the primary resource for market dynamics within the territory to understand decision makers’ evolving information needs to feed into the ongoing value-proposition development process for product and non-product offerings • Effectively communicates and coordinates with Regional Medical Scientific Director (RMSD) regarding medical and scientific support needs in key health systems accounts • Serves as a resource for the HS MAD Team Lead, HS Executive Director Medical Affairs, and other members of Country Medical Affairs on other relevant strategic planning • Attends and supports scientific and medical meetings and prepares post-meeting deliverables

• Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit • Provides medical leadership of utilization management, cost containment, and medical quality improvement activities • Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services, ensuring timely and quality decision making • Supports effective implementation of performance improvement initiatives for capitated providers • Assists Chief Medical Director in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members • Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements • Assists the Chief Medical Director in the functioning of the physician committees including committee structure, processes, and membership • Conducts regular rounds to assess and coordinate care for high-risk patients, collaborating with care management teams to optimize outcomes • Collaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing complex cases and medical necessity appeals • Participates in provider network development and new market expansion as appropriate • Assists in the development and implementation of physician education with respect to clinical issues and policies • Identifies utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components • Identifies clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice to improve the quality and cost of care • Interfaces with physicians and other providers to facilitate implementation of recommendations to improve utilization and health care quality • Reviews claims involving complex, controversial, or unusual or new services to determine medical necessity and appropriate payment • Develops alliances with the provider community through the development and implementation of medical management programs • Represents the business unit before various publics both locally and nationally on medical philosophy, policies, and related issues as needed • Represents the business unit at appropriate state committees and other ad hoc committees • May be required to work weekends and holidays as needed.

Role Description Como Médico/a de Clínica Geral, terás um papel essencial no acompanhamento clínico da população, prestando cuidados primários, assegurando diagnósticos precoces e promovendo a saúde preventiva. - Realizar consultas de telemedicina no âmbito dos cuidados de saúde primários em contexto agudo a doentes de todas as idades, residentes em Portugal ou a cidadãos portugueses no estrangeiro. - Atendimento de doentes encaminhados pelo SNS24, em telemedicina. - Assegurar a boa qualidade dos registos clínicos, incluindo, mas não limitado a: registo de consultas, diagnóstico de consultas e formulários específicos de telemedicina. - Assegurar que todos os procedimentos clínicos relacionados com a telemedicina sejam executados adequadamente, incluindo, mas não se limitando a: prescrição eletrónica de medicamentos, exames, e declarações médicas. - Promover estilos de vida saudáveis e a literacia em saúde da comunidade. Qualifications - Licenciatura em Medicina; - Inscrição ativa na Ordem dos Médicos; - Experiência clínica mínima de 1 ano em atendimento de doentes em contexto de doença aguda e crónica; - Facilidade na utilização de plataformas digitais; - Capacidade de comunicação empática e próxima; - Disponibilidade para realizar turnos fixos de 4 horas seguidas nos seguintes horários: Segunda a Sexta: Entre as 8h e as 18h. Requirements - Experiência prévia em telemedicina e projetos de saúde digital será uma mais-valia; - Disponibilidade imediata. Benefits - Integração numa equipa altamente diferenciada, presente, acessível e de reconhecida competência técnica e científica; - Formação clínico-científica por médicos especialistas nas áreas médicas de relevo; - Formação na área da medicina digital e das novas tecnologias em saúde; - Acesso à plataforma líder de Saúde Digital em Portugal; - Acesso às mais recentes tecnologias em saúde.