Medical Manager at Rovedana

RESPONSIBILITIES

• Ensures all administrative reports are sent within allotted timelines.
• Provider contracting, registration & sign up
• Provider profiling, categorization and audit
• Build-up of provider directory
• Tariff Building for providers
• Provider reaccreditation and due diligence
• Provider education
• Provider relations management
• Enrolee referrals within and outside the provider network, both locally and internationally
• Review and filing of medical reports and specialist consultations
• Case management being follow up on all enrolee admissions including major OR high costing procedures
• Introduction & development of cost saving initiatives e.g. activation of pharmacy network, IMG, Travcure, et cetera.
• Organization of provider forums
• Pre-authorization
• Utilization monitoring & actuarial support for underwriting purposes
• Cost management
• Regular provider visitation and engagement
• Provider allotment
• Provider profitability reviews
• Ensure providers get their monthly capitation list timely and have it for the respective month at their front desk
• NHIS operations update and follow through on related directives
• Observation and compliance with use of Quality assurance tools for providers
• Itinerary visitation reports for providers sent on a monthly basis
• Actual visitation reports for providers sent on a monthly basis
• Retrieval of Encounter data and Claims data from providers on a monthly basis within stipulated timelines
• Generation and sign off on memos for provider payments
• Provider reconciliation and sign off
• Provider claims trending report
• Provider case management reports
• Management of exclusions
• Management of refunds
• Participation in creation of e-platform applications
• Preventative care management including but not limited to management of Onsite Clinics, In-house clinics, Pre-employment tests for clients, content writing for newsletters, health talks and schedules, wellness programs,
• Biostatistics: Disease Specific Report statistics (Diabetes, Hypertension, Malaria), Mortality and Birth reports any other task assigned by the HOD.

QUALIFICATION/REQUIREMENTS

• Bachelor Degree in Surgery/Medicine.
• Professional qualification in MD, or MBCHB, or MBBS, and MBA, or MPH or post graduate qualification in a health related field.
• Post NYSC experience with at least 3 years in the HMO industry
• Masters in Relevant fields including but not limited to Public Health, Health Informatics, Health Economics, Healthcare Financing, Healthcare Policy etc.