Medical Governance Consultant

MediCard Phils., Inc. is one of the country's leading HMO and the only HMO founded and run by Doctors. Since its inception, the concept of service-oriented total health care has been the molding ideal of MediCard. The competition is vast, and the benefits being offered by the competitors are tempting. However, MEDICard has taken the lead in providing innovative and productive ideas that cut down the cost of health maintenance without compromising its quality.

MediCard now boasts of more than half a million members and over 54,000 accredited doctors in over 1,000 hospitals and clinics nationwide. It also operates 16 MediCard free-standing clinics that provide services at par with those offered by hospitals minus the confinement.

MediCard is currently looking for assertive, dynamic and energetic individuals to fill up the following vacancy:

The Medical Governance Lead is responsible for developing, updating, and overseeing clinical governance policies, ensuring consistent documentation, and enforcing quality assurance standards across free-standing clinics, occupational health departments, company clinics, telemedicine services, and provider networks. The role includes managing medical-related complaints concerning doctors and ensuring compliance with regulatory standards and best practices. The Medical Governance Lead will collaborate with healthcare professionals, clinical leaders, and external stakeholders to maintain high standards of care, patient safety, and service quality across all healthcare services.DUTIES & RESPONSIBILITIES
1. Develop, review, and update clinical governance policies to ensure that healthcare practices in free-standing clinics, occupational health departments, company clinics, and telemedicine services meet current regulatory and industry standards. Draft and implement SOPs for clinical operations, ensuring alignment with governance policies and the organization’s strategic goals. Ensure that governance policies are effectively communicated to all medical staff, clinic heads, and external healthcare providers, with training and support provided where necessary. Ensure that all policies comply with local, national, and international healthcare regulations and are regularly reviewed to reflect changes in legislation or best practices.
2. Establish and maintain quality assurance processes for the management and operation of free-standing clinics, occupational health departments, and telemedicine services, ensuring they adhere to clinical governance standards. Lead regular clinical audits to assess compliance with policies, identify areas for improvement, and implement corrective actions where necessary. Oversee the creation, review, and maintenance of clinical documentation to ensure accurate and complete record-keeping, including patient records, incident reports, and quality assurance data. Implement a continuous improvement framework by analyzing audit results, patient outcomes, and feedback from healthcare staff, ensuring best practices are followed consistently.
3. Develop and manage a process for handling complaints, ensuring all complaints are investigated thoroughly and resolved promptly. Lead investigations into complaints related to clinical care, patient safety, or professional conduct involving doctors in free-standing clinics, occupational health departments, company clinics, and telemedicine. Implement corrective actions based on the findings of investigations and ensure that any necessary training, policy changes, or disciplinary actions are carried out. Ensure comprehensive documentation of all complaints, investigations, and outcomes, maintaining transparency and accountability. Provide regular reports to senior management on the nature and resolution of complaints, highlighting trends and recommending preventive measures.
4. Collaborate with the provider management team to ensure that doctors and other healthcare providers meet the organization’s clinical governance standards and are regularly recredentialed. Ensure that external healthcare providers (hospitals, specialists, etc.) meet the same quality and clinical governance standards as in-house providers, with regular audits and assessments. Work with clinic heads and occupational health leaders to provide training and guidance to doctors and healthcare providers on clinical governance policies, quality assurance measures, and best practices in patient care.
5. Develop and enforce clinical standards for the management and operation of free-standing clinics, occupational health departments, and telemedicine services to ensure consistency in care and compliance across all services. Establish and maintain quality and safety standards for telemedicine services, ensuring that virtual consultations meet the same clinical governance requirements as in-person care. Work closely with the occupational health team to ensure that clinical standards specific to occupational health services are followed, including compliance with health and safety regulations and best practices in employee healthcare.
6. Oversee the reporting and investigation of clinical incidents, adverse events, and near misses, ensuring lessons are learned and appropriate preventive measures are taken. Ensure all clinical practices adhere to ethical guidelines, legal requirements, and patient confidentiality standards, with a focus on risk mitigation and patient safety. Conduct regular risk assessments to identify potential clinical risks and work with the management team to develop strategies for mitigating these risks.
7. Work closely with the heads of free-standing clinics, company clinics, and occupational health departments to ensure smooth implementation of governance policies and quality standards. Liaise with external healthcare providers, regulatory bodies, and accreditation agencies to ensure that all healthcare services provided by the organization comply with industry regulations and standards. Collaborate with HR, legal, compliance, and clinical operations departments to address governance-related issues and ensure organizational alignment with governance policies. Ensure all services meet regulatory requirements and maintain ISO certification or other relevant quality certifications.

FINANCIAL MEASURES
• Manage the financial impact of medical-related complaints, ensuring cost-effective resolutions and minimizing the risk of legal claims.
• Ensure that quality assurance programs and audits are conducted within budget, with a focus on cost-effective improvements to clinical standards.

NON-FINANCIAL MEASURES
• Measure and improve the time taken to resolve medical-related complaints, ensuring prompt investigation and follow-up actions.
• Monitor compliance rates with clinical governance policies through regular audits, ensuring high standards of care across all clinics and services.
• Track and improve the percentage of medical staff who have completed required training on clinical governance policies and quality assurance measures.
• Monitor and improve patient safety indicators, such as adverse event rates, incident reporting, and patient outcomes.

MINIMUM QUALIFICATIONS
• Education – bachelor’s degree in medicine, nursing, healthcare management, or a related field. Advanced degree (e.g., master’s in healthcare administration, Public Health) or certification in clinical governance, quality management, or healthcare compliance is preferred.
• Experience – Minimum of 8-10 years of experience in a healthcare governance, clinical leadership, or quality assurance role. Proven experience in policy development, complaint resolution, and managing clinical documentation.
• Technical / functional skills: Strong leadership, communication, and problem-solving skills. Deep understanding of healthcare regulations, quality assurance practices, and clinical governance frameworks.
• Business skills: In-depth knowledge of local and international healthcare standards, including ISO certification and accreditation processes.

At MediCard, we believe that diversity and inclusion are essential to fostering innovation, collaboration, and growth. We are committed to creating a workplace where everyone, regardless of gender, race, ethnicity, age, sexual orientation, disability, or any other characteristic, feels valued and empowered to contribute their unique perspectives and talents.

Our inclusive hiring practices ensure that we attract, hire, and retain the best talent from all backgrounds. We strive to provide equal opportunities for all candidates and promote a culture of respect, fairness, and transparency. We are dedicated to continuously improving our processes and policies to eliminate biases and barriers, ensuring that every employee has the support and resources they need to thrive.

MediCard is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.

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