Unit Lead, Medical Operations at HR Leverage Africa

Job Description

  • Ensure that the unit meets its operational objectives as it relates to providers satisfaction, prompt payment of claims and medical utilization management
  • Supervise the Unit Lead, Claims and Unit Lead, Provider/Case Management
  • Responsible and accountable to Management through the Head of Medical Operations

Responsibilities

  • Supervise and manage day-to-day itinerary of Case Managers
  • Supervise and manage the day-to-day Case Management activities, utilization reviews, quality management activities and medical outreach or education programs
  • Collate report of medical case reviews/audit, present findings, propose improvement plans and monitor strict execution of the improvement plans
  • Collate report of utilization reviews, present findings, propose solution and monitor implementation of plans
  • Collate report of accreditation and re-accreditation of providers and present findings for approval
  • Co-ordinate and collate report of claims reconciliation with providers, present findings and resolutions and monitor execution of resolutions as well as collection of Letters of Non-Indebtedness (LONI)
  • Co-ordinate the collation of regulatory report including monthly Fee-For-Service FFS) and Referral report, Quarterly Provider Sensitization and Itinerary report
  • Co-ordinate the Pharmacy Benefit Program (Pharm-Assist) to manage medical cost from drugs (medications) without compromising client convenience
  • Co-ordinate Medical Referral program to manage medical cost without compromising client convenience
  • Co-ordinate the Claims Administration team to ensure prompt claims processing and payment to providers in line with the organization’s contract with the providers
  • Manage high level relationships within every healthcare facility to ensure continued high quality service delivery
  • Coordinate the prompt resolution of all escalated provider or claim grievance issues
  • Monitor and evaluate the day-to-day performance of the Case Managers and Claims Adjusters

Qualification

  • MBBS or B.Sc Degree in Nursing from an accredited College, MPH or MBA would be an added advantage
  • Minimum of nine (9) years Post-Qualification experience
  • Minimum of seven (7) years cognate experience in a Health Maintenance Organisation (HMO)
  • Must have led a team of ten (10) staff minimum
  • Proven track record of achievement and high performance with evidence

Competence:

  • Complex problem solving
  • Critical thinking
  • Judgment and decision making
  • People management
  • Collaboration

Application Closing Date
Not Specified.

How to Apply
Interested and qualified candidates should send their Applications to: [email protected] using the Job Title as the subject of the email.

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Company Information
  • Total Jobs 32 Jobs
  • Full Address ADEBOLA HOUSE, 38 Opebi Road, Suite 100, Via Back CarPark, CubeHub Wing Opebi Bus Stop Ikeja, Opebi 100281, Lagos
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