JOB TITLE: Consultant Medical Officer
NO. OF POSITIONS: 1
LOCATION: Lucknow (Uttar Pradesh)
ORGANIZATION BACKGROUND:
ACCESS Health International is a non-profit think tank, advisory group, and implementation partner committed to transforming health systems globally. With a mission to improve access to high-quality, affordable healthcare for all, ACCESS Health collaborates with national and regional governments, academia, development partners, and the private sector to design and strengthen healthcare delivery systems.
Established in 2007, ACCESS Health operates across South Asia, Southeast Asia, the Middle East and North Africa, and the United States. Through research, technical support, advisory services, capacity building, and convening health systems networks, the organization works to strengthen health systems and support vulnerable communities.
ACCESS Health envisions a world where everyone, regardless of location or age, has the right to high-quality and affordable healthcare to lead healthy and productive lives. To achieve this, the organization takes a comprehensive health systems approach, addressing and improving the key building blocks of healthcare.
JOB SUMMARY
The Government of India announced Ayushman Bharat in 2018. Ayushman Bharat, a major health sector reform, aims at making interventions in primary, secondary and tertiary care systems, covering both preventive and promotive health, to address healthcare holistically. The program includes two major health initiatives namely, Health and Wellness Centers and Pradhan Mantri Jan Arogya Yojana (PMJAY). The PM-JAY will cover over 10 crore (one hundred million) poor and vulnerable families (approximately 50 crore (five hundred million) beneficiaries) providing coverage up to 5 lakh rupees ($7,100) per family per year for secondary and tertiary care hospitalization.
ACCESS Health provides implementation support to the State Health Agencies in Uttar Pradesh in implementation of Pradhan Mantri Jan Arogya Yojana (PM-JAY) towards building state leadership in evidence-based implementation, use of efficient, multisectoral and cost-effective interventions for increasing beneficiaries’ access to quality healthcare, improved experience and reduced out of pocket expenditure. ACCESS Health seeks to on-board services of a Medical Specialist to provide advisory and capacity support to the implementation of the scheme.
The position will be based in SACHIS-State Agency for Comprehensive Health and Integrated Services, Government of Uttar Pradesh.
KEY RESPONSIBILITIES
Medical Adjudication and Case Review
- Review and provide medical opinions on claims flagged through fraud analytics, SAFU/NAFU mechanisms, and other audit processes.
- Support review of disputed, rejected, escalated, and exceptional PM-JAY claims requiring medical assessment.
- Assist SACHIS in reviewing cases placed before grievance redressal and review committees.
- Provide technical inputs on suspected cases of forgery, manipulation, unnecessary procedures, and other provider malpractices.
Audits and Quality Assurance
- Support medical audits, desk reviews, mortality audits, and facility assessments under PM-JAY.
- Assist in identifying patterns of inappropriate utilization, coding errors, upcoding, package misuse, and quality concerns.
- Participate in field audits and provider assessments as required.
- Support development and implementation of quality assurance processes and audit protocols.
Provider Network Strengthening
- Support provider engagement and capacity building on PM-JAY guidelines, package protocols, documentation standards, and claims processes.
- Assist in improving provider compliance and quality of care delivery.
- Support initiatives to strengthen provider performance monitoring and quality improvement.
Program Support
- Analyse medical and provider performance data to generate operational insights and recommendations.
- Develop reports, briefing notes, presentations, and technical documentation as required.
- Support other PM-JAY implementation activities and special projects assigned by SACHIS and ACCESS Health.
QUALIFICATIONS, EXPERIENCE AND COMPETENCIES:
Qualifications
- A medical graduate (MBBS) from recognized university in India along with registration for clinical practice with relevant Authority India.
- Preference will be given to candidates with postgraduate qualifications in Public Health, Hospital Administration, Healthcare Management, Community Medicine, or related disciplines.
Experience
- 2–5 years of relevant experience in clinical practice, health insurance, medical audits, claims adjudication, hospital quality, public health programs, or healthcare operations.
- Experience with PM-JAY, health insurance schemes, utilization review, or hospital administration will be an advantage.
- Fresh postgraduates with strong interest in health systems and health insurance may also be considered.
Skills and Competencies
- Passionate about health systems and looking to create an impact
- Adheres to global standards of professionalism and end excellence
- Is a team player/ believes in a cohesive working environment of growth.
- Good listening skills and open to new ideas / flexibility / adaptability
- In-depth understanding of the hospitals processes, policies and procedures will be desirable along with the ability to verify Medical, billing related documents for further claim processing as well as from frauds perspective
- Good spoken and written communication skills, including ability to prepare clear and concise reports will be preferred.
- Well versed in windows, MS-office.
- Training skills would be an added advantage
- Willing to travel to districts for field audits supporting SACHIS.
NATURE OF EMPLOYMENT:
The selected candidate shall be offered a fixed term contract for one-year (renewable)
REPORTING TO:
Global Director Programs
GRADE LEVEL: M3
HOW TO APPLY:
Eligible candidates interested in this position are requested to share your resumes with the job title mentioned in the subject line to below email id by June 24, 2026.