About the role
To lead the hospital''s managed-care function, owning the interface with HMOs and retainership schemes, and ensuring enrolee service, claims and authorisation processes deliver both quality care and commercial sustainability.
Responsibilities
Direct the hospital''s managed-care operations and manage relationships with HMO and retainership partners.
Oversee enrolee verification, pre-authorisation, referrals and management of care within scheme terms.
Oversee claims preparation, submission, reconciliation and follow-up to minimise rejections and delays.
Monitor service-level agreements and lead resolution of disputes with scheme partners.
Coordinate with clinical teams to ensure care is evidence-based, cost-effective and within scheme rules.
Supervise, coach and develop managed-care, clinical support and customer experience staff.
Track managed-care performance and revenue, and report findings with improvement recommendations.
Champion enrolee experience, complaints resolution and retention across the function.
Required skills
Strong knowledge of managed-care, HMO and retainership processesUnderstanding of claims, authorisation and revenue-cycle managementAbility to align clinical and commercial requirementsAbility to lead, coach and develop a team
Strong communication, negotiation and analytical skillsWorking knowledge of managed-care/claims systems and performance reporting
Experience
Minimum of 8 years of relevant experience in managed care, HMO liaison or healthcare administration, including supervisory experience.
Substantial experience in managed care, health insurance, HMO operations or hospital revenue-cycle management.
Experience coordinating claims, authorisations and HMO/scheme relationships.
Experience supervising staff and managing service performance.
Role-specific: Experience working at the interface of clinical and commercial functions in a healthcare setting.
Education
A relevant first degree (e.g. health sciences, nursing, public health, business administration, or a related discipline). Completion of NYSC, or a valid exemption where applicable.