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MetroHealth HMO Limited is a Health Maintenance Organization which has been established with the objective of becoming the HMO of choice for corporate entities and all subscribing enrolees, who want good quality healthcare accessed through a technology enabled platform that will enhance the whole customer experience. The platform has been configured towards …
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- Job Type Full Time
- Qualification BA/BSc/HND
- Experience 10 years
- Location Lagos
- Job Field Medical / Healthcare
- Educate providers on new systems, processes and procedures in managed care and health insurance.
- Provider engagements via visits and phone calls for necessary updates and follow up
- Coordinate, track and monitor the administration of exclusions and to ensure prompt payments by all parties and payment to the providers.
- Notify providers of changes in HMO operational modalities.
- Monitor and coordinate care of the enrollees and ensure care coordination within and outside of network
- Prepare and provide case note audits, report and recommend improvement
- Carry out onsite investigation of complaints with a view to resolving them.
- Investigate critical incident and reviewing outcome of results
- Handle grievance and complaints from all stakeholders – enrollees, clients and providers
- Coordinate emergency out of network care and enrollee referrals.
- Development and implementation of patient care policies and protocols
- Managing the implementation of the Medicloud technology platform as it relates to providers, and contributing to the website content and implementation with Medical and non-medical interventions.
- Provider enlightenment activity report
- Medical records review
- Provider satisfaction survey report
- Provider satisfaction reviews
- Provider termination & disengagement reviews
- Provider report carding & incentivizing reports
- Network adequacy assessment report
- Provider accessibility and availability report
- Case management reports
- Credentialing review
- Credentialing report
- Provider contracting report.
- Organizational process mapping
- Administrative process review (filing system audit, system fee schedule audits, system benefit and premium audit)
- Client and provider contract reviews
- Minimum of 10 years post NYSC experience in clinical practices
- Valid practitioners license
- Fully qualified and registered with Medical and Dental Council of Nigeria
- Effective time management, communication and organizational skills.
- Previous experience of working in an HMO.
Method of Application
Interested and qualified candidates should send their CV to: email@example.com using the JobTitle as the subject of the mail.
- Only shortlisted candidates will be contacted
- Experience in HMO industry is compulsory
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