Provider Network Manager

Doheney Services

Full time

Lagos, Nigeria

Feb 11

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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