Welcome, Guest: Register On Nairaland / LOGIN! / Trending / Recent / NewStats: 3,153,615 members, 7,820,183 topics. Date: Tuesday, 07 May 2024 at 11:01 AM |
Nairaland Forum / Nairaland / General / Jobs/Vacancies / Provider Network Operations Manager (158 Views)
VACANCY:Network Operation Center Manager And Network Operations Center Operator / Vacancy - Network Operations Center ADHOC / Network Operations Center Engineer (2) (3) (4)
(1) (Reply)
Provider Network Operations Manager by desolas(f): 3:24pm On Nov 23, 2021 |
Our client, Nigeria’s first advanced paramedic (Emergency Medical Services) company is looking for passionate Provider Network Operations Manager to join its team. Job Designation: Provider Network Operations Manager Job Location: Lagos, Contact Centre Person Specification: • Minimum education: bachelor’s degree • Minimum inherent job experience required: medical customer service experience • Desirable experience: 5 years clinical experience • Communication verbal and written • Prioritize tasks and responsibilities • Planning/Organizing • Interpersonal skills • Business Acumen • Negotiation Responsibilities Manage the Healthcare Provider Network • Develop a provider network • Draft, review, negotiate, and finalize all contracts with all providers in the network - Contract Management Involved in the development of and responsible for the implementation of the network development and contracting strategy. • Must continually develop an in-depth knowledge of contracting and negotiation principles in order to secure results that achieve the objectives of the network strategy. • Ensures the proper negotiation of all provider contracts. • Responsible to fully understand the network landscape in order to ensure network adequacy and anticipate future needs. • Ensures the proper execution of contracts per their negotiated language and provides any needed clarity related to the contracts intent. • Responsible to ensure contract language is kept up-to-date and relevant codes and information are reflected accurately. • Leads in the development of all network adequacy reporting and working closely with internal teams to ensure an efficient process by which information is gathered and reported. • Interfaces with all applicable internal and external stakeholders related to network adequacy including, but not limited to, identified gaps and the strategy to fill those gaps. • Credentialing of providers • Establish and maintain processes and systems to provide services to all members • Relationship management with providers to ensure that our customers experience superior quality Manage 3rd Party Provider Network • Ensure compliance with contract guidelines. • Prepare financial projections. • Facilitate membership growth. • Customize fee schedules with all providers • Anticipate customer needs and proactively establish network solutions to fulfill them • Build strong business relationships with hospitals, physicians, pharmacies, surgical centers, and other ancillary providers. • Continuously safeguards the liability exposure through the monitoring of compliance with the relevant policies and procedures, and state and federal requirements as they pertain to network providers. Administration • Promote functional teamwork • Utilization Reviews • Records management and case sheets • Develop, review and implement procedures to meet customer requirements • Prepare Utilization reports for Clients • Providing the Billings Department with accurate information for payments, Medical Insurance and Client Billings • Assisting with any other management tasks requested by Senior Management • Ensure all case notes and details regarding patients is captured on the EMR • Develop a Provider Escalation procedure and SLA Training & Awareness • Continuous training, development of our products to all providers • Continuous feedback to the providers relating to service deliver, compliments, complaints and feedback Finance • Deliver a service within budget and agreed performance • Cost containment and efficient utilization of resources • Monitor income and expenditure • Profitability of cases and the use of third parties / service providers • Risk identification and management • Product development and offering Quality Assurance • Manage and improve the quality of services provided by the network • Manage and improve the quality of third parties / service providers • Analyze, review and recommend on technical and operational software • Liaise with IT to ensure accurate databases are always maintained Interested candidate should send their CVs to gts.recruitments@gmail.com with job title as the subject of the mail |
(1) (Reply)
Sales Executive Needed In Port-harcourt / How To Enable Inspect Element On Any Smartphone / How To Save Any Article As PDF On Android Chrome Browser
(Go Up)
Sections: politics (1) business autos (1) jobs (1) career education (1) romance computers phones travel sports fashion health religion celebs tv-movies music-radio literature webmasters programming techmarket Links: (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) Nairaland - Copyright © 2005 - 2024 Oluwaseun Osewa. All rights reserved. See How To Advertise. 16 |