HRLeverage delivers excellent spectrum of HR Business Solutions and strategic management support services through a customs built approach for organisations. As a premium professional HR Boutique firm domicile in Africa, with our global pertners, we leverage on technology in providing a on-stop human resources services to various industries in terms of staffing, outsourcing, executive search and recruitment, Hr advisory, HR4SMEs, Expatriate management.
We are recruiting to fill the position below:
Job Title: Unit Lead, Medical Operations
Location: Nigeria
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
Qualifications
- 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
How to Apply
Interested and qualified candidates should send their Applications to: resume@hrleverageafrica.com using the Job Title as the subject of the email.
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