Head, Business Development & Managed Care

Head, Business Development & Managed Care

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...

Head, Business Development & Managed Care

• Job Type Full Time
• Qualification BA/BSc/HND
• Experience 8 years
• Location Lagos
• Job Field Sales and Business Development

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 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.

• Nice to have

• Experience in a multi-specialty hospital, corporate hospital network or HMO-facing health system.

Experience

• A minimum of 8 years of relevant experience in managed care, HMO liaison or healthcare administration, including supervisory experience.

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.

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 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.

• Nice to have

• Experience in a multi-specialty hospital, corporate hospital network or HMO-facing health system.

Experience

• A minimum of 8 years of relevant experience in managed care, HMO liaison or healthcare administration, including supervisory experience.

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.