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
