Regional Medical Manager
6d ago
source : myJobmag
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    Rovedana Limited - 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.

    To oversee a team Medical Officers)

    Location : Port Harcourt, Rivers


    Has purview over unit medical managers and ensures the functions of the unit are well administeredEnsures all administrative reports are sent within allotted timelines.

    Provider contracting, registration & sign upProvider profiling, categorization and auditBuild-up of provider directoryProvider cluster reviews for geographical coverage for the regionTariff Building for providersProvider reaccreditation and due diligenceProvider educationProvider relations managementEnrolee referrals within and outside the provider network, both locally and internationallyReview and filing of medical reports and specialist consultationsCase management being follow up on all enrolee admissions including major OR high costing proceduresIntroduction & development of cost saving initiatives , IMG, Travcure, et cetera.

    Organization of provider forumsPre-authorizationUtilization monitoring & actuarial support for underwriting purposesCost managementRegular provider visitation and engagementProvider allotmentProvider profitability reviewsEnsure providers get their monthly capitation list timely and have it for the respective month at their front deskNHIS operations update and follow through on related directivesObservation and compliance with use of Quality assurance tools for providersItinerary visitation reports for providers sent on a monthly basisActual visitation reports for providers sent on a monthly basisRetrieval of Encounter data and Claims data from providers on a monthly basis within stipulated timelinesGeneration and sign off on memos for provider paymentsProvider reconciliation and sign offProvider claims trending reportProvider case management reportsManagement of exclusionsManagement of refundsParticipation in creation of e-

    platform applicationsPreventative 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.

    Qualification / Requirements

    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.

    Method of Application

    Applicants should send their CV's to : 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.

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