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  • Posted: Feb 3, 2021
    Deadline: Feb 15, 2021
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    MacTay Consulting has been in existence for over 28 years in Nigeria. We are a member of TACK and TMI, international consulting companies operating in over 60 countries and with a combined experience of over 80years. Our global network of partners and experience means that our clients enjoy all the benefits of a local office, while drawing upon our multi...
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    Head Medical Operations and Quality Assurance

    Job Summary

    • The Head, Operations will oversee key functions (such as: Healthcare Provider Accreditation and Contracting, claims management, Complaints resolutions, Authorizations) which are aimed at providing quality healthcare services to members.

    Job Responsibilities

    • Develop Strategies, Policies and Plans for ensuring access to quality healthcare services including Quality Improvement Plans
    • Provide technical input for costing and actuarial analysis.
    • Establish mechanisms for reducing provider and enrolee moral hazards.
    • Advice Management on present and future operational requirements and risks; proffer solutions for mitigating risks. ▪ Provide periodic reports across units in the department
    • Perform other strategic functions assigned by the Board.
    • Define Service standards and develop Service Level Agreements with
    • HCPs and contracted parties
    • Develop and periodically review tariffs for services.
    • Monitoring of Utilizations & Medical Loss Rations (MLR)
    • Review and approve Panel lists and Claims.
    • Oversee referral activities and high-cost treatments.
    • Oversee the 24hours call centre operations.
    • Drive Operational efficiency and cost optimization.
    • Accredit and re-accredit all levels of HCPs
    • Oversee conduct of Clinical Audits and verification exercises on services delivered.
    • Manage stakeholders involved in service delivery to ensure services.
    • Meet with agreed standards defined in the Service Level Agreements
    • Foster cordial relationships with clients, healthcare providers and other stakeholders
    • Ensure implementation of appropriate sanctions for erring stakeholders/Players.
    • Provide leadership and direction for Operations department.
    • Manage performance, mentor, and coach team.

    Job Requirements

    • Minimum of a Bachelor's Degree or equivalent in Medicine, Pharmacy, or other health-related disciplines
    • Postgraduate degree in Public Health, Health Administration, & Management, Health Economics, or a related degree will be an added advantage.
    • Minimum of 10 years experience with at least five years in a managerial capacity
    • Experience in handling the Operations of a health insurance institution is mandatory.

    Method of Application

    Interested and qualified candidates should send their detailed CV (not more than 3pages) to: using the Job Title as the subject of the email.

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