Regional Medical Manager

Rovedana Limited

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Rovedana Limited - Our client, one of the largest Healthcare insurance providers in Nigeria offering optimum services that is second to none in the healthcare industry. Their mode of operations encompasses a friendly environment and smart use of technology which enables them to offer excellent HMO services to their clients who are spread across multiple industries in West Africa.

Job Description:

  • Has purview over unit medical managers and ensures the functions of the unit are well administered
  • Ensures all administrative reports are sent within allotted timelines.
  • Provider contracting, registration & sign up
  • Provider profiling, categorization and audit
  • Build-up of provider directory
  • Provider cluster reviews for geographical coverage for the region
  • Tariff Building for providers
  • Provider reaccreditation and due diligence
  • Provider education
  • Provider relations management
  • Enrolee referrals within and outside the provider network, both locally and internationally
  • Review and filing of medical reports and specialist consultations
  • Case management being follow up on all enrolee admissions including major OR high costing procedures
  • Introduction & development of cost saving initiatives e.g. activation of pharmacy network, IMG, Travcure, et cetera.
  • Organization of provider forums
  • Pre-authorization
  • Utilization monitoring & actuarial support for underwriting purposes
  • Cost management
  • Regular provider visitation and engagement
  • Provider allotment
  • Provider profitability reviews
  • Ensure providers get their monthly capitation list timely and have it for the respective month at their front desk
  • NHIS operations update and follow through on related directives
  • Observation and compliance with use of Quality assurance tools for providers
  • Itinerary visitation reports for providers sent on a monthly basis
  • Actual visitation reports for providers sent on a monthly basis
  • Retrieval of Encounter data and Claims data from providers on a monthly basis within stipulated timelines
  • Generation and sign off on memos for provider payments
  • Provider reconciliation and sign off
  • Provider claims trending report
  • Provider case management reports
  • Management of exclusions
  • Management of refunds
  • Participation in creation of e-platform applications
  • Preventative care management including but not limited to management of Onsite Clinics, In-house clinics, Pre-employment tests for clients, content writing for newsletters, health talks and schedules, wellness programs,
  • Biostatistics: Disease Specific Report statistics (Diabetes, Hypertension, Malaria), Mortality and Birth reports any other task assigned by the HOD.

Job Requirement:

  • Bachelor Degree in Surgery/Medicine.
  • Professional qualification in MD, or MBCHB, or MBBS, and MBA, or MPH or post graduate qualification in a health related field.
  • Minimum of 10 years post NYSC, (with at least 3 years in the HMO industry).
  • Masters in Relevant fields including but not limited to Public Health, Health Informatics, Health Economics, Healthcare Financing, Healthcare Policy etc.

Note: 

  • Only qualified candidates that live in the specified location will be contacted for an interview.

This job originally appeared elsewhere.

Summary

Company

Rovedana Limited

Job Level

Manager (Staff Supervisor/Head of Department)

Location

Rivers

Specialization

Healthcare / Pharmaceutical

Job Type

Full-Time

Minimum Qualification

MBBS

Preferred Years of Experience

10 - 15 years