Our client, one of the largest Healthcare insurance providers in Nigeria offering optimum services that is second to none in the healthcare industry.Their mode of operations encompasses a friendly environment and smart use of technology which enables them to offer excellent HMO services to their clients who are spread across multiple industries in West Africa.
Responsibilities
- Has purview over unit medical managers and ensures the functions of the unit are well administered
- Ensures all administrative reports are sent within allotted timelines.
- Provider contracting, registration & sign up
- Provider profiling, categorization and audit
- Build-up of provider directory
- Provider cluster reviews for geographical coverage for the region
- Tariff Building for providers
- Provider reaccreditation and due diligence
- Provider education
- Provider relations management
- Enrolee referrals within and outside the provider network, both locally and internationally
- Review and filing of medical reports and specialist consultations
- Case management being follow up on all enrolee admissions including major OR high costing procedures
- Introduction & development of cost saving initiatives e.g. activation of pharmacy network, IMG, Travcure, et cetera.
- Organization of provider forums
- Pre-authorization
- Utilization monitoring & actuarial support for underwriting purposes
- Cost management
- Regular provider visitation and engagement
- Provider allotment
- Provider profitability reviews
- Ensure providers get their monthly capitation list timely and have it for the respective month at their front desk
- NHIS operations update and follow through on related directives
- Observation and compliance with use of Quality assurance tools for providers
- Itinerary visitation reports for providers sent on a monthly basis
- Actual visitation reports for providers sent on a monthly basis
- Retrieval of Encounter data and Claims data from providers on a monthly basis within stipulated timelines
- Generation and sign off on memos for provider payments
- Provider reconciliation and sign off
- Provider claims trending report
- Provider case management reports
- Management of exclusions
- Management of refunds
- Participation in creation of e-platform applications
- Preventative care management including but not limited to management of Onsite Clinics, In-house clinics, Pre-employment tests for clients, content writing for newsletters, health talks and schedules, wellness programs,
- Biostatistics: Disease Specific Report statistics (Diabetes, Hypertension, Malaria), Mortality and Birth reports any other task assigned by the HOD.
Bachelor Degree in Surgery/Medicine.
Professional qualification in MD, or MBCHB, or MBBS, and MBA, or MPH or post graduate qualification in a health related field.
Minimum of 10 years post NYSC, (with at least 3 years in the HMO industry).
Masters in Relevant fields including but not limited to Public Health, Health Informatics, Health Economics, Healthcare Financing, Healthcare Policy etc.
Applicants should send their CV's to: [email protected] The subject of the mail should be "Regional Medical Manager - PH"
Note: Only qualified candidates that live in the specified location will be contacted for an interview.