About this role
Coordinator, Managed Care Services
Dragnet Solutions Limited - Coordinator, Managed Care Services
About the Role
To lead the hospital's managed-care function, owning the interface with HMOs and retainership schemes, and ensuring enrollee 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 enrollee 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 enrollee experience, complaints resolution and retention across the function.
Requirements
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.
Required skills
- Strong knowledge of managed-care, HMO and retainership processes
- Understanding of claims, authorisation and revenue-cycle management
- Ability to align clinical and commercial requirements
- Ability to lead, coach and develop a team
- Strong communication, negotiation and analytical skills
- Working 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.
- Experience working at the interface of clinical and commercial functions in a healthcare setting.
Application Closing Date
6th October, 2026.