Head Medical Operations and Quality Assurance at MacTay Consulting

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.