Care Coordinator / Provider Manager at International Health Management Services (IHMS) - 5 Openings

IHMS is a national Health Maintenance Organization (HMO) established in 2001 to provide Social Health Insurance coverage to individuals and groups under the National Health Insurance Scheme and private health insurance services to interested individuals and groups. It is owned by medical practitioners and Institutional investors.

We are recruiting to fill the position below:

Job Title: Care Coordinator / Provider Manager

Locations: Abuja, Edo, Lagos, Niger, and Rivers
Employment Type: Full-time

Responsibilities 

• Inspection of healthcare facilities and accreditation of new facilities for onboarding and re-credentialing.
• Annual recertification/re-credentialing of all Providers.
• Annual collection of LONI certificates from all Providers.
• Provider relationship management and Provider Forums.
• Provider staff education – Provider induction at sign-on and ongoing education.
• Scheduling and carrying out quality assurance (QA) visits.
•  Assist with Pre-authorization of care based on the company’s pre-authorization guidelines and procedure.
• Investigating complaints from hospitals and responding to such correspondences.
• Investigating medical-related complaints from clients and responding to such correspondences.
• Health promotion (education, screening, etc.) and health benefit utilization education for clients.
• Concurrent and retrospective reviews of Enrollee feedback
• Providing approved billing guides and tariffs to hospitals
• Providing timely reports on Provider management
• Providing IHMS with feedback on Provider Relationship with IHMS
• Following up and getting feedback from Enrollees on admission Care
• Ensuring all correspondences with Providers are documented in email, reporting structure, survey or formal report as much as possible.

Duties

• Reach out to Patients on Admission
• Call or visit Patients during or at most one (1) week after admission
• Use the structured template to collect Patient reviews on Providers
• Provide feedback and utilization data
• Get feedback from Enrollees on treatment at various facilities
• Report on Enrollee utilization for each facility every year
• Reduce overbilling and over treatment
• Follow-up issues raised by the Claims Department to help Providers improve services

Requirements

• Possess relevant qualifications
• HMO experience will be an added advantage

Application Closing Date
22nd August, 2023.