Job Title: Head Medical Operations and Quality Assurance
Job Location: Lagos
Job Details:
- The Head, Operations will oversee key functions (such as: Healthcare Provider Accreditation and Contracting, claims management, Complaints resolutions, Authorizations) which are aimed at providing quality healthcare services to members.
Job Responsibilities
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- Develop Strategies, Policies and Plans for ensuring access to quality healthcare services including Quality Improvement Plans
- Provide technical input for costing and actuarial analysis.
- Establish mechanisms for reducing provider and enrolee moral hazards.
- Advice Management on present and future operational requirements and risks; proffer solutions for mitigating risks. ▪ Provide periodic reports across units in the department
- Perform other strategic functions assigned by the Board.
- Define Service standards and develop Service Level Agreements with
- HCPs and contracted parties
- Develop and periodically review tariffs for services.
- Monitoring of Utilizations & Medical Loss Rations (MLR)
- Review and approve Panel lists and Claims.
- Oversee referral activities and high-cost treatments.
- Oversee the 24hours call centre operations.
- Drive Operational efficiency and cost optimization.
- Accredit and re-accredit all levels of HCPs
- Oversee conduct of Clinical Audits and verification exercises on services delivered.
- Manage stakeholders involved in service delivery to ensure services.
- Meet with agreed standards defined in the Service Level Agreements
- Foster cordial relationships with clients, healthcare providers and other stakeholders
- Ensure implementation of appropriate sanctions for erring stakeholders/Players.
- Provide leadership and direction for Operations department.
- Manage performance, mentor, and coach team.
Job Requirements
- Minimum of a Bachelor’s Degree or equivalent in Medicine, Pharmacy, or other health-related disciplines
- Postgraduate degree in Public Health, Health Administration, & Management, Health Economics, or a related degree will be an added advantage.
- Minimum of 10 years experience with at least five years in a managerial capacity
- Experience in handling the Operations of a health insurance institution is mandatory.
How to Apply
Interested and qualified candidates should send their detailed CV (not more than 3pages) to: [email protected] using the Job Title as the subject of the email.
Deadline: February 15, 2021
Job Features
Job Category | Administration/ Office/ Operations |