Provider Network Manager at Teclab Management Services Limited

Core purpose of the Job

• You'll design and implement programs that help build and nurture positive relationships between the health plan, providers and practice managers.

Task Complexity

• You are expected to work directly and give direct support services to your business unit as it relates to all assignments you may be given.
• Design and implement programs that help us build and nurture positive relationships between the health plan, providers and practice managers
• Implement strategies for the development of provider networks, identify gaps in network composition and services, and assist the network staff to prioritize contracting needs.
• Develop the provider network (physicians, hospitals, pharmacies, ancillary groups & facilities, etc.)
• Yield a geographically competitive, broad access, stable network that achieves objectives for unit cost performance and trend management, and produces an affordable and predictable product for customers and business partners.
• Evaluate and negotiate contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls
• Establish and maintain strong business relationships with Hospital, Physician, Pharmacy, or Ancillary providers, and ensuring the network composition includes an appropriate distribution of provider specialties.
• Manage the development of a healthcare network.
• Oversees the negotiation of managed care or other payer contracts
• Responsible for daily activities, provider relations, and credentialing
• Anticipate customer needs and proactively develop solutions to meet them.

Qualification (s)

• First Degree in Humanities, Master’s degree in business, health care management or related field
• Job Specification (Experience & Training) Academic and Professional: First Degree in Humanities or Social Sciences and MBA will be an added advantage.
• Minimum of 7 Years’ Experience, with 5 Years’ Experience in a Network Management Role.

Job Specific Competencies (Skills/ Knowledge/ Attributes):

• Entrepreneurial and Numerical Competence
• Business Consulting and Development
• Competency Management
• Complaint & Conflict Management (Emergency/ Crisis Management)
• Customer Focus
• Information Management
• Learning and Self Development
• Negotiation

Key performance Objectives and Indicators:

• To ensure that volume and value target is achieved through effective business development
• Volume and value of sales target achieved
• Relevance towards the overall success of the organization
• Effective administration and cost effective Resource Management
• Achievement of all set targets