Senior Medical Auditor

Ministry of Health
Project Management Unit (PMU)
Request for Expressions of Interest
Consulting Services – Individual Consultant

Country: Palestine
Project: Health System Resiliency Strengthening Project (HSRSP)
Grant No.: TF018986
Assignment Title: Senior Medical Auditor

Reference No. : MOH-WB/ CS9-C

The Palestine Liberation Organization for the benefit of the Palestinian Authority has received a grant from the International Development Association 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 Senior Medical Auditor/Evaluator to provide the support for the Services Purchasing Unit (SPU) at the Ministry of Health for improving the rationality, transparency efficiency and effectiveness of the Outside Medical Referrals (OMR) processes and its results. More specifically, the Medical Auditor is required to:

-Assess the medical component of the OMR’s according to the most accepted and best practices in terms of Diagnosis, Management and Treatment of applications for OMR submitted to the SPU;
-Assess the adequacy, appropriateness, and effectiveness of the procedures performed by the Services providers regarding the diagnosis, management or treatment of the OMR’s patients and its results;
-Perform analysis, extract conclusions and make recommendations to the Service Purchase Unit (SPU) General Director and SPU team, oriented to improve the referrals processes and mechanisms.
-Ensure the Quality of care provided to the OMR’s patients from the Services Provider according to the contract agreements and patient satisfaction; and
-Develop and implement a Monitoring and Evaluation framework including its indicators (using the SMART conceptual definitions) in order to increase efficiency, transparency effectiveness and rationality of the OMR applications and its respective decision-making process, including the assessment of compliance levels either of the SPU and Services Providers according to the defined Indicators.

The Ministry of Health/Project Management Unit invites eligible qualified individual consultants to provide information indicating their: qualifications, experience and appropriate skills to perform the services. The main qualifications of the consultant are as follows:

-A University Professional from the Medical Sciences area, preferable a Medical Doctor specialist in Internal Medicine, or Family Medicine with a training in Medical audits and ICD 10 Coding system.
-General Experience: Not less than 6 years of experience in Medical Evaluation/Auditing of Diagnostics, management and treatment procedures for the different types of conditions, or illnesses ( either from the different specialties of the Medical practice including subspecialties)   frequently requiring OMR in Palestine, as well as, previous working in similar position (as medical auditor), in the public or private sector and demonstrated knowledge of Medical auditing procedures and proven knowledge of nomenclature and usage the ICD 10 coding system.
-Specific and proven knowledge or skills of:

a.Medical Audit procedures, based in world recognized best practices (including NICE, UAE Medical Protocols, or other systems) accepted in Palestine.
b.Special instruction of norms and regulations related to services purchase.
c.Palestinian National Authority’s financial systems.
d.Knowledge of the usage of the E-Referral system.
e.Proven knowledge of M&E framework and indicators for services providers in the health sector including the existing norms, procedures and regulations of the OMR in the SPU.

Other significant requirements are

-Demonstrated ability to work effectively in team-based environment,
-Excellent personal integrity and confidentiality.
-Knowledge of the Palestinian Law of Medical Insurance
-A very good level of English, Arabic and Hebrew languages.

The contract will be a Time-Based contract for twelve (12) 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. 

Individual Consultants may obtain further information at the address below from 8:00 AM to 3:00 PM from Sunday to Thursday .Expressions of interest must be delivered to the address or e-mail below by 20/4/2017: 

Ministry of Health
Project Management Unit (PMU)
Ramallah, West Bank
E-mail: [email protected]
Tel/Fax: 02 2966260
 

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