Medical Reviewer for Local hospitals

The Palestine Liberation Organization for the benefit of the Palestinian Authority has received a grant from the International Development Association (IDA) toward the cost of the Health System Resiliency Strengthening Project, and it intends to apply part of the proceeds to payments for consulting services to be procured under this project.

The consulting services (“the Services”) include the selection of a qualified and experienced Medical Reviewer for local hospitals as a support for the Services Purchasing Unit (SPU) to contribute to the improvement of the rationality, transparency, efficiency and effectiveness of the Outside Medical Referrals (OMR) process and its results. More specifically, the Medical Reviewer is expected to perform the following with update to the SPU director and team:

1. Review all existing forms in the patient file to validate the potential information and to assess the quality of information in the files, including but not limited to medical reports, indications, prescriptions, procedures, diagnostic procedures…etc. provided by both the MOH referring hospital and the referral facility.
2. Review each individual medical record to check for any missing documentation. 
3. Revision of change requests for referred patients submitted by the referral facilities and perform required changes approved by the referral committees. 
4. Ensure that all services provided by the referral facility are in compliance with the referral protocols and guidelines, and in accordance with the contracts/MOUs with the referral facilities.
5. Keep updated on the MOH Essential Drug List and medications outside the list as well as the new coding systems and health insurance guidelines.
6. Conducting periodic medical review visits to the contracted referral facilities and carry out random checks on claims and their supporting documents to ensure compliance, and consistency with ICD-10 classification. 
7. Ensure the availability of needed documents and information on the E-referral system.
8. Review and assess the level of patient satisfaction with the service quality provided by the referral facility and report to the SPU director. 
9. Maintain continuous communications with the case managers and coordinators within the SPU and at the referral facilities and provide medical and administrative support for them.
10. Participate in the capacity building of the SPU team and case managers on Monitoring and Evaluation Framework and quality indicators for medical processes and proper documenting procedures.

The Ministry of Health invites eligible qualified Medical Doctors to provide information indicating their qualifications, experience and appropriate skills to perform the services.

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The main qualifications of the Medical Doctors are as follows:

A University degree in Medicine from a recognized University (as per the WHO list) (certified).

General Experience: Not less than 3 years of experience in medical evaluation, management and treatment procedures for the different types of conditions, or illnesses frequently requiring referrals in Palestine and proven knowledge of and usage the ICD-10 coding system and ICD-9/10 PCS. 

Specific and proven knowledge or skills of:

1. Medical Reviewing procedures, based on best practices (Referral Protocols, DRGs, or other systems) accepted in Palestine.
2. Guidelines related to strategic purchase of services. 
3. Knowledge in the Palestinian National Authority’s financial systems.
4. Knowledge of the usage of the E-Referral system.
5. Proven knowledge of M&E framework and how to set indicators. 

Other significant requirements are:

1. Fluent in Arabic and English languages.
2. Excellent computer skills.
3. Demonstrated ability to work effectively in a team.
4. Excellent personal integrity and confidentiality.
5. Knowledge of the Palestinian Law of Health Insurance.

The contract will be a Time-Based contract for a period of Seven months to be renewed based on the performance evaluation and availability of fund.

The attention of interested Consultants is drawn to paragraph 1.9 of the World Bank’s Guidelines: Selection and Employment of Consultants under IBRD Loans and IDA Credits & Grants by World Bank Borrowers dated January 2011 (revised July 2014) (“Consultant Guidelines”), setting forth the World Bank’s policy on conflict of interest.