Coordinator, Managed Care Services at Dragnet Nigeria

About the role

• A reputable multi-specialist hospital in Nigeria is recruiting for the role of Coordinator, Managed Care Services.
• The role involves leading the hospital's managed-care function, managing relationships with HMOs and retainership schemes, and ensuring optimal enrolee service, claims and authorization processes that deliver both quality care and commercial sustainability.
• The role reports to the Chief Medical Officer or relevant management lead and includes responsibilities such as overseeing managed-care operations, coordinating with clinical teams, and supervising staff.

Responsibilities

• Direct the hospital's managed-care operations and manage relationships with HMO and retainership partners.
• Oversee enrolee verification, pre-authorisation, referrals and management of care within scheme terms.
• Oversee claims preparation, submission, reconciliation and follow-up to minimize rejections and delays.
• Monitor service-level agreements and lead resolution of disputes with scheme partners.
• Coordinate with clinical teams to ensure care is evidence-based, cost-effective and within scheme rules.
• Supervise, coach and develop managed-care, clinical support and customer experience staff.
• Track managed-care performance and revenue, and report findings with improvement recommendations.
• Champion enrolee experience, complaints resolution and retention across the function.

Requirements
Experience:

• Minimum of 8 years of relevant experience in managed care, HMO liaison or healthcare administration, including supervisory experience.
• Substantial experience in managed care, health insurance, HMO operations or hospital revenue-cycle management.
• Experience coordinating claims, authorisations and HMO/scheme relationships. Experience supervising staff and managing service performance.

Education:

• A relevant first degree (e.g. health sciences, nursing, public health, business administration, or a related discipline). Completion of NYSC, or a valid exemption where applicable.

Required skills

• Strong knowledge of managed-care, HMO and retainership processes.
• Understanding of claims, authorisation and revenue-cycle management.
• Ability to align clinical and commercial requirements.
• Ability to lead, coach and develop a team.Strong communication, negotiation and analytical skills.
• Working knowledge of managed-care/claims systems and performance reporting.