Vacancies

Job Title:

Head, Provider Services

Job Objective/ Purpose of Job:

This position will provide functional and technical leadership for all medical and administrative resources, processes and activities required to guarantee the provision of quality healthcare services to HCHC enrolees at designated HCHC providers

Key business processes supported include:

·         Care coordination oversight

·         Provider Utilization/Claims reporting

·         Provider upgrade and quality improvement

·         Business performance reporting.

Department/Division/ Unit:

Provider Services

Location:

Lagos

REPORTING RELATIONSHIPS:

Functionally Reports To:

Managing Director

Administratively Reports To:

Programme Coordinator

Supervises:

Care coordinators (Lagos & Kwara)

WORKING RELATIONSHIPS:

Internal

Sales & Enrolment, Data management, Claims and Accounts

External

Providers: MDs, Quality teams and other personnel

Job Duties/ Responsibilities/ Accountabilities:

·         Leadership and oversight of the Provider Services Unit

·         Responsible for Provider contracting  

·         Responsible for development and implementation of annual provider upgrade plans

·         Responsible for the development, implementation and review of evidence based clinical guidelines for the management of critical medical conditions etc

·         Responsible for the development, implementation and review of SOPs for designated non-medical processes such as enrollee identity verification, enrollee benefit administration, data management etc

·         Liaising with Providers to ensure implementation of designated data management protocols including utilization and claims data collation and reporting

·         Proactive review of claims to determine discrepancies, trends and opportunities for disease

management and allied medical/non medical interventions

·         Proactive review of encounter data to determine disease patterns, trends and opportunities for disease management and allied intervention

·         Provide input for internal and external capacity building activities for HCHP staff and Provider staff respectively

·         Provide input for associated business process improvement activities

Key Performance Indicators/ Performance Goals:

·         Case management index

·         Utilization review and control of claims reimbursement

·         Implementation of Quality upgrade plans

·         Completeness and accuracy of utilization data reports

Financial Dimensions:

·         Implementation of scheduled upgrade activities within budget

·         Achieving designated quality targets/standards (associated income)

JOB SPECIFICATIONS:

Education Qualification:

·         Minimum of a higher education qualification (HND or university degree)

·         An MBBS degree will be an advantage

Professional Qualification:

·         None required

Experience

 (Dimension and Noof years)

·         Minimum of 5 years post graduation

·         Quality Assurance/Monitoring and Evaluation experience in a health care environment

·         Experience in Provider administration in a managed care environment will be an advantage

Others

Preferred, but not required:

·         Experience in data analysis

KEY COMPETENCIES REQUIREMENTS:

Functional/ Technical:

·         Care coordination administration

·         Monitoring and Evaluation

·         Development/evaluation of evidence based clinical guidelines

·         Project management

·         MS Office suite – average/above average proficiency

Managerial:

·         Strong written and verbal communication skills, with attention to detail.

·         Strong business partnering skills.

·         Strong analytical, organizational, and multi-tasking skills.

·         Energetic, highly self-motivated and able to work efficiently and productively.

·         Professional disposition and ability to maintain confidentiality

·         Proactive and solution minded attitude

·         Target driven

·         Ability to work under little or no supervision

Behavioural:

·         Excellent Interpersonal Skills

WORK CYCLE (HOURS/ DAYS):

Monday - Friday   

(8.30 a.m. - 5.00 p.m.)

Monday – Friday ( 8.30am – 5.00pm)