Provider Manager at Oceanic Health Management Limited

Job Duties/ Responsibilities/ Accountabilities:

• Supervision of general medical operations activities
• Coordination of Provider payment mechanisms
• Provider profiling and audit
• Observation and compliance with use of quality assurance tools for Providers
• Supervision of guidance and observance of NHIS operational protocols
• Timely submission of NHIS statutory reports
• Build-up of Provider directory and excellence centers enhancing the Provider network optimally
• Provider cluster reviews for geographical coverage for the regions
• Approvals for provider contracting, registration & sign up
• Provider categorization for optimal profitability
• Medical operation process development and implementation
• Organization of internal meetings to enhance productivity and profitability
• Presentation of medical operations administrative reports, ensuring they are sent within allotted timeline
• Provider education and organization of Provider forums
• Oceanic Health staff education on provider idiosyncrasies, behavior & benefits
• Provider relations management, enhancing provider perception of OHML operations
• Departmental document filing and record keeping
• Escalation of departmental requirements to other relevant units
• Complaint management and grievance resolution
• Care coordination for enrollees at provider healthcare facility including co-management of cases with attending physicians at healthcare facility
• Enrollee referrals within and outside the provider network, both locally and internationally
• Review and filing of medical reports and specialist consultations
• Assurance of care delivery with zero denial of access to care for covered benefits
• Introduction & development of cost saving initiatives e.g., activation of pharmacy network etc.
• Utilization monitoring
• Provision of cost management initiatives and implementation
• Regular provider visitation and engagement
• Provider allotment reviews
• Provider profitability reviews and management reports
• NHIS operations update and follow through on related directives
• Supervision of compliance with use of quality assurance tools for providers
• Supervising itinerary of visitation, actual visitation and reports for providers sent monthly
• Management of exclusions
• Management of referral cases
• Management of onsite clinics for deserving clients
• Preventative care management including but not limited pre-employment test for clients, content writing for newsletters, health talks and schedules as well as wellness programs
• Monthly provider directory dissemination
• Any other task and duty as assigned by the supervisor, HOD

REQUIREMENTS

• Minimum of Bsc/HND in Health-related degrees/Registered Nurse e.t.c.
• Preferable with at least 2 to 3 years’ experience in HMO is a plus.
• Candidate must reside in the location applying for.

Functional/ Technical:

• Good clinical skills
• Apt administrative skills
• Excellent handling of Microsoft Office tools
• Good negotiation skills
• Relationship management skills

Managerial:

• Ability to multi-task
• Problem solving
• Analytical expertise
• Innovative capability
• Discreet

Behavioral:

• Heightened interpersonal skills.
• Excellent communication skills
• Time management skills
• Organizational skills

Salary range: 150,000-250,000 net (depending on experience).