Medical Manager at Oceanic Health Management Limited

DEPARTMENT: MEDICAL OPERATIONS

Job Duties/ Responsibilities/ Accountabilities:

• Supervision of general medical operations activities
• Coordination of Provider payment mechanisms
• Provider profiling and audit
• Observation and compliance with use of quality assurance tools for Providers
• Supervision of guidance and observance of NHIS operational protocols
• Timely submission of NHIS statutory reports
• Build-up of Provider directory and excellence centers enhancing the Provider network optimally.
• Provider cluster reviews for geographical coverage for the regions.
• Approvals for provider contracting, registration & sign up.
• Provider categorization for optimal profitability.
• Medical operation process development and implementation.
• Organization of internal meetings to enhance productivity and profitability.
• Presentation of medical operations administrative reports, ensuring they are sent within allotted timeline.
• Provider education and organization of Provider forums.
• Oceanic Health staff education on provider idiosyncrasies, behavior & benefits
• Provider relations management, enhancing provider perception of OHML operations.
• Departmental document filing and record keeping.
• Escalation of departmental requirements to other relevant units.
• Complaint management and grievance resolution.
• Care coordination for enrollees at provider healthcare facility including co-management of cases with attending physicians at healthcare facility.
• Enrollee referrals within and outside the provider network, both locally and internationally.
• Review and filing of medical reports and specialist consultations.
• Assurance of care delivery with zero denial of access to care for covered benefits.
• Introduction & development of cost saving initiatives e.g., activation of pharmacy network etc.
• Utilization monitoring.
• Provision of cost management initiatives and implementation.
• Regular provider visitation and engagement.
• Provider allotment reviews.
• Provider profitability reviews and management reports.
• NHIS operations update and follow through on related directives.
• Supervision of compliance with use of quality assurance tools for providers.
• Supervising itinerary of visitation, actual visitation and reports for providers sent monthly.
• Management of exclusions.
• Management of referral cases.
• Management of onsite clinics for deserving clients.
• Preventative care management including but not limited pre-employment test for clients, content writing for newsletters, health talks and schedules as well as wellness programs.
• Monthly provider directory dissemination.
• Any other task and duty as assigned by the supervisor, HOD.

Education Qualification: MBBS

At least 2 to 3 years’ experience in HMO is essential. 

Functional/ Technical:

• Good clinical skills.
• Apt administrative skills.
• Excellent handling of Microsoft Office tools.
• Good negotiation skills.
• Relationship management skills.

Managerial:

• Ability to multi-task.
• Problem solving.
• Analytical expertise.
• Innovative capability.
• Discreet.

Behavioral:

• Heightened interpersonal skills.
• Excellent communication skills.
• Time management skills.
• Organizational skills.

Salary Package:

Very Attractive and Negotiable