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  • Posted: Jul 6, 2021
    Deadline: Not specified
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  • HRLeverage Africa is an HR, Outsourcing and Recruitment Service Provider. As a company, we deliver excellent spectrum of HR Business Solutions through a custom-built approach for organizations. We are a premium professional service firm domiciled in Africa and with our partnership with global organizations, we are able to leverage on technology to provide strategic Business solution.
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    Head of Medical Operations- MBBS

    Ensure that the unit meets its operational objectives as it relates to providers satisfaction, prompt payment of claims and medical utilization management

    Supervise the Unit Lead, Claims and Unit Lead, Provider/Case Management

    Responsible and accountable to Management through the Head of Medical Operations.

    SPECIFICS

    • Supervise and manage day-to-day itinerary of Case Managers
    • Supervise and manage the day-to-day Case Management activities, utilization
    • reviews, quality management activities and medical outreach or education programs
    • Collate report of medical case reviews/audit, present findings, propose improvement
    • plans and monitor strict execution of the improvement plans
    • Collate report of utilization reviews, present findings, propose solution and monitor implementation of plans
    • Collate report of accreditation and re-accreditation of providers and present findings for approval
    • Co-ordinate and collate report of claims reconciliation with providers, present findings and resolutions and monitor execution of resolutions as well as collection of Letters of Non-Indebtedness (LONI)
    • Co-ordinate the collation of regulatory report including monthly Fee-For-Service FFS) and Referral report, Quarterly Provider Sensitization and Itinerary report
    • Co-ordinate the Pharmacy Benefit Program (Pharm-Assist) to manage medical cost from drugs (medications) without compromising client convenience
    • Co-ordinate Medical Referral program to manage medical cost without compromising client convenience
    • Co-ordinate the Claims Administration team to ensure prompt claims processing and payment to providers in line with the organization’s contract with the providers
    • Manage high level relationships within every healthcare facility to ensure continued high quality service delivery
    • Coordinate the prompt resolution of all escalated provider or claim grievance issues
    • Monitor and evaluate the day-to-day performance of the Case Managers and Claims Adjusters

    QUALIFICATION 

    • MBBS or BSc Nursing from an accredited College, MPH or MBA would be an added advantage

    • Minimum of nine (9) years Post-Qualification experience

    • Minimum of seven (7) years cognate experience in a Health Maintenance Organisation (HMO)

    • Must have led a team of ten (10) staff minimum

    • Proven track record of achievement and high performance with evidence

    COMPETENCE

    • Complex problem solving

    • Critical thinking

    • Judgment and decision making

    • People management

    • Collaboration

    Method of Application

    Interested and qualified candidates should forward their CV to: [email protected] using the position as subject of email.

    Note: Never pay for any training, certificate, assessment, or testing to the recruiter.

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