Oceanic Health Management Limited is one of the largest Healthcare insurance providers in Nigeria offering optimum services that is second to none in the healthcare industry. Our friendly environment and smart use of technology has enabled us offer excellent HMO services to our clients who are spread across multiple industries in Nigeria.
We are recruiting to fill the position below:
Job Title: Provider Manager
Locations: Yaba - Lagos, Asaba - Delta, Port Harcourt - Rivers and Edo
Employment Type: Full-time
Job Duties / Responsibilities / Accountabilities
Supervision of general medical operations activities
Coordination of Provider payment mechanisms
Provider profiling and audit
Observation and compliance with use of quality assurance tools for Providers
Supervision of guidance and observance of NHIS operational protocols
Timely submission of NHIS statutory reports
Build-up of Provider directory and excellence centers enhancing the Provider network optimally
Provider cluster reviews for geographical coverage for the regions
Approvals for provider contracting, registration & sign up
Provider categorization for optimal profitability
Medical operation process development and implementation
Organization of internal meetings to enhance productivity and profitability
Presentation of medical operations administrative reports, ensuring they are sent within allotted timeline
Provider education and organization of Provider forums
Oceanic Health staff education on provider idiosyncrasies, behavior & benefits
Provider relations management, enhancing provider perception of OHML operations
Departmental document filing and record keeping
Escalation of departmental requirements to other relevant units
Complaint management and grievance resolution
Care coordination for enrollees at provider healthcare facility including co-management of cases with attending physicians at healthcare facility
Enrollee referrals within and outside the provider network, both locally and internationally
Review and filing of medical reports and specialist consultations
Assurance of care delivery with zero denial of access to care for covered benefits
Introduction & development of cost saving initiatives e.g., activation of pharmacy network etc.
Utilization monitoring
Provision of cost management initiatives and implementation
Regular provider visitation and engagement
Provider allotment reviews
Provider profitability reviews and management reports
NHIS operations update and follow through on related directives
Supervision of compliance with use of quality assurance tools for providers
Supervising itinerary of visitation, actual visitation and reports for providers sent monthly
Management of exclusions
Management of referral cases
Management of onsite clinics for deserving clients
Preventative care management including but not limited pre-employment test for clients, content writing for newsletters, health talks and schedules as well as wellness programs
Monthly provider directory dissemination
Any other task and duty as assigned by the supervisor, HOD
Requirements
Minimum of BSc/HND in Health-related degrees/Registered Nurse e.t.c.
Preferable with at least 2 to 3 years’ experience in HMO is a plus.
Candidate must reside in the location applying for.
Functional / Technical:
Good clinical skills
Apt administrative skills
Excellent handling of Microsoft Office tools
Good negotiation skills
Relationship management skills
Managerial:
Ability to multi-task
Problem solving
Analytical expertise
Innovative capability
Discreet
Behavioral:
Heightened interpersonal skills.
Excellent communication skills
Time management skills
Organizational skills
Salary Range
N150,000 - N250,000 net (depending on experience).
Application Closing Date
23rd February, 2024.
Method of Application
Interested and qualified candidates should send their CV to: [email protected] using the position applied with intending location in bracket as the subject of the mail