Job Title: Officer 2, Provider Management (Medical Operations )
Reports To: Head, Medical Operations
Job Objective:
Involves all the activities and procedures adopted by the HMO to ensure an effective and efficient oversight on the provider-enrollee relationship, build a mutually beneficial relationship with healthcare providers and ensure that the business remains profitable.
Responsibilities:
- Sign up of providers across the country
- Provider selection and management: enlisting, negotiation, delisting, rewarding, training, enlightening
- Tariff negotiation and review
- International Providers selection and management
- Scheduling major and highly specialized patient procedure
- Utilization Review Management (total review of all enrollees that receive care within the period)
- Case Management – concurrent and post-management review with managing physicians
- Providers audit and quality assurance: this involves infrastructure audit, treatment protocol compliance, service quality
- Care review for admitted and complex cases in a secondary and tertiary care
- Review of care delivery protocols
- Analysis of hospitals tiers and capability
Requirements:
- Bachelor of medicine, bachelor of surgery
- Minimum 0 - 3 years total work experience
- Knowledge of the function
- Knowledge of the Business
- Analysis and development of solutions
- Decision-making autonomy
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