Regional Medical Manager at a Leading Healthcare insurance Firm

Employment Nigeria 24-May-2018 LAGOS , Health Administrative

Rovedana Limited - Our client, a leading Healthcare insurance Service provider is recruiting to fill the post of : Regional Medical Manager (To oversee a team Medical Officers)

Qualification

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.

Responsibilities

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
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
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.

How To Apply
Candidates should send their CV's to:resume@rovedana.com with "Regional Medical Manager - PH" as the subject of the mail

Sorry the application deadline for this job has elapsed

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Regional Medical Manager at a Leading Healthcare insurance Firm

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