Head, Health Services & Quality Assurance at Avant Halogen

Avant Halogen is an integrated talent risk management and outsourcing solutions company. We deliver innovative talent management using our cutting-edge digital solutions that drive business performance.

We are recruiting to fill the position below:

Job Title: Head, Health Services & Quality Assurance

Location: Lagos

Job Summary

• The key employee for this function is the Head, Health Services & Quality Assurance.
• Reporting into this role are the Quality Assurance Officer, Hospital Monitoring & Inspection, Claims Officer (vertically), Provider Management Unit, Call Centre Agents and Care/ Case Manager.

Responsibilities

• The operational head of this department is responsible for monitoring the quality of health services provided to enrollees and the delivery processes, including the digital space follow up.
• S/he shall be responsible for Inspection and Credentialing of providers and the review of credentialing tools in alignment with NHIS review from time to time. Furthermore, he shall facilitate the joint forum with providers for tariff structuring and reviews, as it relates to drugs, investigations and services and shall render updates to the SPC for advice to the Head of ICT and Underwriting in the reflection of same in the respective providers Contract and HMO software update as and when reviews are done. This shall form a major appraisal index for reviewing the performance of the holder of this office quarterly.
• S/he shall work hand-in-gloves with the MD/CEO to drive the strategic investment partnership focus of PUO HMS Limited from the point of identifying the key areas of investment, advice to the Board and to the execution of the strategic focus of the company and effective monitoring/Follow up for reports on monthly basis to the CEO for discussion at the Strategic Planning Committee meeting of PUO HMS Limited and subsequent quarterly reports to the Board of Directors by the MD/CEO appropriately. This shall form a major appraisal index for reviewing the performance of the holder of this office quarterly.
• S/he shall work in alliance with the Head of Underwriting Department and Head of Business Development on strategic acquisition of enrollees and retention of same, and this key function shall serve as a major appraisal index for the holder of this office as it relates to the business growth and profitability, on monthly basis.
• S/he shall be responsible for the evaluation of physicians performance for the purpose of :
  • Sanctioning poor performance and recommending remedies
  • Tracking malpractice claim(s) filed against such by any enrollee and reporting same to the Strategic Planning Committee for expedite action.
  • Collating grievance information from the enrollees directly, joint interactive forums and/or through Call Centre daily reports of feedbacks.
• S/he shall conduct satisfaction survey on all partner providers nationwide on monthly basis, to align with the Monthly Statistical Returns (MSR) and Encounter Data submitted by physicians/healthcare facility providers for validation of the integrity of such reports, for submission to NHIS and deliberation by the Strategic Planning Committee (SPC).
• S/he shall be responsible for provider facilities’ review for the purposes of identifying “positive ads on” and “negative drop offs” in the strategic investment partnership, vis-à-vis value to the enrollees and the NHIS scheme, for sustainability of the vision of PUO HMS Limited. Furthermore, the review shall extend to the responsibility of promptly coopting healthcare providers hitherto not captured on PUO HMS network but accredited by NHIS and suggested by any new client(s) coming onboard PUO HMS scheme within the moratorium of signing on the client. This shall form a major appraisal weight for the holder of this office, amongst other key performance indices (KPIs).
• S/he shall establish quality control protocols and standard operating procedures for all laboratory procedures as well as Treatment protocols according to the World Health Organization (WHO) standard and Federal Ministry of Health Template for management/treatment of tropical diseases, to form the reference for use in adoption of case-based tariff structure by all partner healthcare providers (for drugs, investigations and services), to effectively monitor quality of care and institute control against abuses, in the overall interest of mutual profitability by all stakeholders.
• S/he shall establish direct contractual relationship with a robust independent network of secondary care providers, such as the Pharmaceutical outlets, Dental Care providers, Ophthalmology/Optometrists/Opticians, Orthopedic Surgeons, and other rare specialties for efficiency in secondary referrals by direct authorization from PUO HMS end (where life is being put at risk by the bureaucracy at the primary care facility of any enrollee) and for accident and emergency cases that may come directly under the purview of PUO HMS Limited, whilst upholding the ethics and practice of managed care without compromise to life at any point and with the overall objective of mutual profitability to all stakeholders.
• S/he shall be responsible for establishing and overseeing the Case Management unit for improved authorization of care, referral of care and cost-effective follow up on admission, as well as prompt investigation of enrollee queries and refund requests. This shall form a major appraisal index for the holder of this office on monthly basis.
• S/he shall set up a Claims Appraisal & Adjudication Unit which shall ensure prompt settlement of claims within the agreed moratorium with the respective healthcare providers from inception of accepting a validated claim to have been submitted to the point payment is received by the respective healthcare facility. S/he shall employ the use of electronic date stamp for incoming claims and outgoing vetted bills, for internal control purposes and ease of reconciliation of any query from an aggrieved provider, in a manner that no backlog of claim is accommodated, In this regard, S/he shall work with the SPC to set a cutoff date for acceptance of liability on any claim and s/he shall be responsible for communicating this policy to the partner healthcare facilities and secondary care providers to avoid erring providers being victims of bad debt, which shall no longer be entertained by PUO HMS Limited, as shall be contained in Healthcare Providers Contract. This shall form a major appraisal index on monthly basis for the holder of this office.
• S/he shall work with the Credit Control Unit in Finance & Accounts Department to advise the SPC on cash backing projections for claims payment on monthly basis, such that PUO HMS Limited is never under financial liquidity pressure at any time, in honoring her covenanted responsibilities to partner healthcare facilities. This shall form a major joint appraisal index for the holder of this office and the Head of Finance & Accounts Department on monthly basis.
• S/he shall directly oversee the staffing requirement (in conjunction with the Head of Human Resources and the MD/CEO expeditiously) and efficient operations of the 24 hours Call Centre Mondays through Sundays, as the reporting line of the Call Centre staff. S/he shall review the Call Center reports on daily basis at the resumption of work every work day in the week, with the view to generating the necessary report for use by the SPC at the weekly meeting of the latter, for improvement of services and advice to Business Development Department for innovations that give the company a leadership edge. S/he shall be held liable for any disservice, loss or acts that portends danger to the corporate growth, profitability, and sustainability of PUO HMS Limited traceable to any act of negligence and/or dereliction of duty by staff of the Call Centre or downtime of the Call Centre at any point in time, which was never flagged to the SPC. This shall form a major appraisal index on monthly basis, in reviewing the performance of the holder of this office.
• S/he shall be responsible for relationship with government regulatory bodies at the federal, state and local government levels and advise PUO HMS Limited on compliance, as it relates to its operations as health organization, from time to time.

Requirements

• The Person to occupy this Office is required to be a Dedical Doctor or Dental Surgeon with a minimum Bachelor’s Degree in Medicine (MBBS or MB ChB) or Dental Surgery (BDS). A postgraduate qualification in Public Health or any other related field of specialization being an added advantage.
• S/he must have a minimum of Fifteen (15) years post-qualification experience at top management levels in a public or private health institution, not below the level of a Senior Registrar, Principal Manager, or Clinical Head of Unit/Department for at the least ten (10) and with minimum five (5) years cognate experience in the Health Insurance/Managed Care Industry at a level not lower than a Deputy General Manager in any of Hospital Monitoring, Provider Credentialing or Quality Assurance units/Department in any of the leading National HMOs preferably .

Application Closing Date
27th July, 2022.

Method of Application
Interested and qualified candidates should send their CV to: [email protected] using the Job Title as the subject of the mail.