Head, Business Development & Managed Care

About this role

The role leads the hospital’s managed-care function and oversees relationships with HMOs and retainership partners to ensure enrollee service, claims and authorisation stay within scheme terms while delivering quality care and commercial sustainability. It is aimed at a candidate with at least eight years of relevant experience in managed care, HMO liaison or healthcare administration, including supervisory experience.

What you would do

• Direct the hospital's managed-care operations and manage relationships with HMOs 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 and develop managed-care, clinical support and customer experience staff.

What they are asking for

• A minimum of 8 years of relevant experience in managed care, HMO liaison or healthcare administration, including supervisory experience.
• 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.
• Strong knowledge of managed-care, HMO and retainership processes.
• Understanding of claims, authorisation and revenue-cycle management.
• Strong communication, negotiation and analytical skills.

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