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Coordinator, Managed Care Services
About this role
The role is to lead the hospital's managed-care function, manage relationships with HMOs and retainership partners, and ensure enrolee service, claims and authorisation processes deliver quality care and commercial sustainability. It is based in Lagos.
What you would do
- Direct the hospital's managed-care activities and handle partnerships with HMO and retainership partners.
- Supervise enrolee verification, pre-authorisation, referrals and care management in line with scheme terms.
- Supervise the preparation, submission, reconciliation and follow-up of claims to minimise rejections and delays.
- Track service-level agreements and drive resolution of disputes with scheme partners.
- Collaborate with clinical teams to ensure care is evidence-based, cost-efficient and compliant with scheme rules.
- Manage and develop the managed-care, clinical support and customer experience teams.
What they are asking for
- Minimum of 8 years of relevant experience in managed care, HMO liaison or healthcare administration, including supervisory experience.
- Strong knowledge of managed-care, HMO and retainership processes.
- Experience coordinating claims, authorisations and HMO/scheme relationships.
- Experience supervising staff and managing service performance.
- A relevant first degree (health sciences, nursing, public health, business administration or related); NYSC completion or valid exemption.
- Strong communication, negotiation and analytical skills; working knowledge of managed-care/claims systems and performance reporting.
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