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Coordinator, Managed Care Services (BUSINESS DEVELOPMENT & MANAGED CARE)
About this role
Based in Lagos, Dragnet Nigeria is seeking a Coordinator, Managed Care Services to lead the hospital's managed-care function, managing HMOs and retainership partnerships to ensure enrollee service, claims and authorisation are delivered within scheme terms and support commercial sustainability. The candidate should have a minimum of eight years of relevant experience in managed care, HMO liaison or healthcare administration, and hold a relevant degree.
What you would do
- Direct the hospital's managed-care operations and manage relationships with HMO and retainership partners.
- Oversee enrollee verification, pre-authorisation, referrals and care management 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.
What they are asking for
- 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.
- A relevant first degree (health sciences, nursing, public health, business administration or related discipline) and completion of NYSC or valid exemption where applicable.
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