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Date Posted: 02/Apr/2014
Deadline: 14/Apr/2014
  • Specialization Admin / Finance
  • Industry
  • Experience 0 year(s)
  • Location Nigeria

HEAD, CARE MANAGEMENT

Purpose of Job

Managed care is intended to reduce the cost of providing health benefits and improve

the quality of care for organisations and other clients. This role oversees healthcare

providers' network development and management, care coordination, providers’

relations, preventive health and wellness programmes that the company delivers to its

client’s and providers

The incumbent in this role will be responsible for:

 Initiating and implementing actions to ensure stress free access to care by all

legitimate enrolees

 Developing best in class provider network by providing explicit standards for

selecting providers

 Reducing costs by negotiating favourable fees from providers and other

interventions such as disease management, case management, preventive and

wellness initiatives, patient education and utilization management.

 Embarking on utilization review of provider and enrolee and intervening for

correction, quality (clinical and service) improvement programmes and

preventive care.

 Periodic reporting to the CEO on the performance vs budget.

 

Responsibilities

 Formulate policies and develop strategies for the effective management of

provider network nationwide

 Drive initiatives with Underwriters to improve the quality of customers acquired

on the client base

 Initiate the review of products and services according to the various levels of

usage of policy procured.

 Ensure compliance with “The Company” tariffs by providers and supervise

activities of “The

 Company” providers’ network.

 Ensure proper risk management as it concerns the department’s risk exposure.

 Formulate and implement policies and procedures for care coordination,

provider relations, preventive and wellness programmes and carry out health

needs assessment and reports utilization statistics to Management

 

 Draw up of quality assurance programs and initiatives and ensure that a cordial

relationship exists between the providers and HMO resulting in excellent service

delivery

 Embark on periodic analysis of claims – claims trend/patterns, utilization rate

and loss ratio. Coordinate and monitor care services nationwide and minimize

complaints from enrolees

 Analyses, evaluates and presents critical medical information concerning medical

situations to Management and problems of service delivery.

 

KPI’S

 Claims cost

 Turnaround time for delivery of care

 100% access to care for all legitimate enrolees

 Provider perception

 Enrolee perception

 

Qualifications and experience

 First degree in Medicine. Post-Graduate qualification in Health Financing or

Managed Care and other professional medical disciplines

 Have a minimum of 8 years of successful and proven work experience in care

management of corporate clients in the HMO and healthcare sector and clinics. At

least 3 years should have been in a senior management role in managed care

function.

 Proven health management, rapport building, networking and relationship

management skills.

 Entrepreneurial drive, passion and ability to multi task.

 This position requires an individual with high level of integrity and must possess

problem solving, supervisory, interpersonal and communication skills and

should be a leader

 

 

HEAD, CORPORATE CLIENT RETENTION

 

Level Nigeria Level 2

Report to CEO

 

Purpose of Job

 Focused on (a) Acquisition of new clients, and (b) Retention of clients already

acquired. This role has a responsibility to oversee the function of retention of

clients already acquired and handed over by the new clients acquisition function.

 

The incumbent in this role will be responsible for ensuring that:

 

 Developing, implementing and ensuring compliance thereof of a robust process

that will lead to cent per cent retention of clients by; Nurturing a best in class

and structured relationship management framework

 Articulating and implementing strategies to improve the average premium per

enrolee of the retention portfolio so as to improve margins

 Articulating and implementing steps aimed at reducing receivables on premium

to a near zero level.

 Periodic reporting to the CEO on the performance vs budget

 

Responsibilities

 Formulate retention and customer service strategies that will result in growth of

the business

 Oversee the coordination of renewals drives in the corporate market to ensure

targets are met and a strong relationship exists between the clients and HMO

thus leading to high client retention.

 Ensure that the processes and procedures are documented, the team sufficiently

trained and that there is full compliance thereof. Any deviations thereof to be

reviewed and corrective action taken.

 Manage the receivables position of the client and ensure that bills are sent

promptly, at all times. Develops negotiating strategies and positions vis-a-vis

company strategies and operations; examining risks and potentials; estimating

partners' needs and goals.

 Innovate and offer new ideas and approaches for developing healthcare business,

building relationships with other prospective business partners and with other

networks and members where appropriate.

 

 Stay appropriately networked and keeps abreast of trends, news, events and

deadlines, so that all new or enhanced opportunities are exploited.

 

KPI’S

 Revenue

 Trade receivables

 Average premium

 Client satisfaction

 

Qualifications and experience

 First degree in Social Sciences or Business Administration or any related

background.

 Have a minimum of 8 years of successful and proven work experience in

relationship management of corporate clients in the HMO, healthcare sector,

telecoms or banking sector. At least 3 years should have been in a senior

management role in client retention function.

 Proven rapport building, networking and relationship management skills.

 Entrepreneurial drive, passion and ability to multi task.

 This position requires an individual with high level of integrity and must possess

problem solving, supervisory, interpersonal and communication skills and

should be a leader of the highest order.

 Knowledge of the potential of CRM tools in relationship management is a must.

 

Interested and qualified candidates should forward their applications to

[email protected]







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