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 the implementation of Pradhan Mantri Jan Arogya Yojana (PM-JAY) towards building state leadership in evidence-based implementation, use of productive, multisectoral, and cost-effective interventions for increasing beneficiaries’ access to quality healthcare, improved experience, and reduced out-of-pocket expenditure.



ACCESS Health seeks to onboard the services of a Medical Specialist to provide advisory and capacity support to the
- implementation of the scheme.

The position will be based in SACHIS, the 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 facilit

📌 Consultant Medical Officer (Lucknow)
🏢 ACCESS Health International
📍 Lucknow