Medical Doctor at Sterling Health HMO

Sterling Health HMO is a National Health Insurance Agency (NHIA)-accredited Health Maintenance Organization (HMO) that has been providing 24/7/365 quality affordable healthcare service to the public and private sector nationally since 2007.

We are recruiting to fill the position below:

Job Title: Medical Doctor

Location: Lagos

Employment time: Full-time

Job Description

● Conduct medical assessments of enrollees as required for specific programs or cases.

● Provide expert medical opinions and recommendations.

● Participate in case reviews and multidisciplinary team meetings.

Utilization Review and Management:

● Evaluate the medical necessity and appropriateness of healthcare services requested by enrollees or provided by healthcare providers.

● Apply clinical guidelines and protocols to ensure cost-effective and quality care.

● Communicate with healthcare providers to clarify treatment plans and ensure adherence to guidelines.

● Authorize or pre-authorize medical services according to Sterling Health Insurance policies.

● Assist in the evaluation and credentialing of healthcare providers within our network.

● Serve as a medical liaison between Sterling Health Insurance and healthcare providers.

● Participate in provider meetings and address medical-related inquiries.

● Contribute to the development and review of medical policies, procedures, and clinical guidelines.

● Ensure that policies are evidence-based and aligned with best practices.

● Review complex or high-cost claims to ensure medical necessity and appropriate billing.

● Provide medical expertise to the claims processing team.

● Provide medical training and education to non-medical staff on relevant healthcare topics.

● Develop educational materials for enrollees on health-related issues.

Application Closing Date

1st May, 2025.

Method of Application

Interested and qualified candidates should forward their CV to: Sterlinghmo@gmail.com using the job title as the subject of the email.