Provider Network Manager

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