Provider Manager at Oceanic Health Management - 4 Openings

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