Provider Network Operations Manager at U-Connect Human Resources Consulting

Our client, Nigeria’s first advanced paramedic (Emergency Medical Services) company is looking for passionate Provider Network Operations Manager to join its team.

Job Location: Lagos, Contact Centre

Person Specification:

• Minimum education: bachelor’s degree
• Minimum inherent job experience required: medical customer service experience

Desirable experience: 5 years clinical experience

Communication verbal and written

Prioritize tasks and responsibilities

• Planning/Organizing
• Interpersonal skills
• Business Acumen
• Negotiation

Responsibilities

• Manage the Healthcare Provider Network
• Develop a provider network
• Draft, review, negotiate, and finalize all contracts with all providers in the network - Contract Management Involved in the development of and responsible for the implementation of the network development and contracting strategy.
• Must continually develop an in-depth knowledge of contracting and negotiation principles in order to secure results that achieve the objectives of the network strategy.
• Ensures the proper negotiation of all provider contracts.
• Responsible to fully understand the network landscape in order to ensure network adequacy and anticipate future needs.
• Ensures the proper execution of contracts per their negotiated language and provides any needed clarity related to the contracts intent.
• Responsible to ensure contract language is kept up-to-date and relevant codes and information are reflected accurately.
• Leads in the development of all network adequacy reporting and working closely with internal teams to ensure an efficient process by which information is gathered and reported.
• Interfaces with all applicable internal and external stakeholders related to network adequacy including, but not limited to, identified gaps and the strategy to fill those gaps.
• Credentialing of providers
• Establish and maintain processes and systems to provide services to all members
• Relationship management with providers to ensure that our customers experience superior quality
• Manage 3rd Party Provider Network
• Ensure compliance with contract guidelines.
• Prepare financial projections.
• Facilitate membership growth.
• Customize fee schedules with all providers
• Anticipate customer needs and proactively establish network solutions to fulfill them
• Build strong business relationships with hospitals, physicians, pharmacies, surgical centers, and other ancillary providers.
• Continuously safeguards the liability exposure through the monitoring of compliance with the relevant policies and procedures, and state and federal requirements as they pertain to network providers.

Administration

• Promote functional teamwork
• Utilization Reviews
• Records management and case sheets
• Develop, review and implement procedures to meet customer requirements
• Prepare Utilization reports for Clients
• Providing the Billings Department with accurate information for payments, Medical Insurance and Client Billings
• Assisting with any other management tasks requested by Senior Management
• Ensure all case notes and details regarding patients is captured on the EMR
• Develop a Provider Escalation procedure and SLA

Training & Awareness

• Continuous training, development of our products to all providers
• Continuous feedback to the providers relating to service deliver, compliments, complaints and feedback

Finance

• Deliver a service within budget and agreed performance
• Cost containment and efficient utilization of resources
• Monitor income and expenditure
• Profitability of cases and the use of third parties / service providers
• Risk identification and management
• Product development and offering

Quality Assurance

• Manage and improve the quality of services provided by the network
• Manage and improve the quality of third parties / service providers
• Analyze, review and recommend on technical and operational software
• Liaise with IT to ensure accurate databases are always maintained

Interested candidate should send their CVs to gts.recruitments@gmail.com with job title as the subject of the mail