Coordinator, Managed Care Services

Dragnet Nigeria

Dragnet Solutions is a dynamic Information Technology company that specializes in the design, development and implementation of innovative people screening solutions. Since our incorporation in 2007, we have been at the forefront of creating and recreating objective recruitment and application management processes to meet international standards. As official...

Coordinator, Managed Care Services

• Job Type Full Time
• Qualification BA/BSc/HND
• Experience 8 years
• Location Lagos
• Job Field Administration / Facilities , Medical / Healthcare

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.

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