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  • Posted: Jan 14, 2021
    Deadline: Feb 7, 2021
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    MetroHealth HMO Limited is a Health Maintenance Organization which has been established with the objective of becoming the HMO of choice for corporate entities and all subscribing enrolees, who want good quality healthcare accessed through a technology enabled platform that will enhance the whole customer experience. The platform has been configured towards ...
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    Care Coordinator

    Job Responsibilities

    • Educate providers on new systems, processes and procedures in managed care and health insurance.
    • Provider engagements via visits and phone calls for necessary updates and follow up
    • Coordinate, track and monitor the administration of exclusions and to ensure prompt payments by all parties and payment to the providers.
    • Notify providers of changes in HMO operational modalities.
    • Monitor and coordinate care of the enrollees and ensure care coordination within and outside of network
    • Prepare and provide case note audits, report and recommend improvement
    • Carry out onsite investigation of complaints with a view to resolving them.
    • Investigate critical incident and reviewing outcome of results
    • Handle grievance and complaints from all stakeholders – enrollees, clients and providers
    • Coordinate emergency out of network care and enrollee referrals.
    • Development and implementation of patient care policies and protocols
    • Managing the implementation of the Medicloud technology platform as it relates to providers, and contributing to the website content and implementation with Medical and non-medical interventions.
    • Provider enlightenment activity report
    • Medical records review
    • Provider satisfaction survey report
    • Provider satisfaction reviews
    • Provider termination & disengagement reviews
    • Provider report carding & incentivizing reports
    • Network adequacy assessment report
    • Provider accessibility and availability report
    • Case management reports
    • Credentialing review
    • Credentialing report
    • Provider contracting report.
    • Organizational process mapping
    • Administrative process review (filing system audit, system fee schedule audits, system benefit and premium audit)
    • Client and provider contract reviews

    Requirements

    • MBBS
    • Minimum of 10 years post NYSC experience in clinical practices
    • Valid practitioners license
    • Fully qualified and registered with Medical and Dental Council of Nigeria
    • Effective time management, communication and organizational skills.
    • Previous experience of working in an HMO.

    Method of Application

    Interested and qualified candidates should send their CV to: metrovacancies@gmail.com using the JobTitle as the subject of the mail.

    Note:

    • Only shortlisted candidates will be contacted
    • Experience in HMO industry is compulsory

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