MANAGED CARE PROGRAMS MANAGER – BPOMAS

 

PURPOSE OF JOB

a) The Managed Care Programs Manager will be reporting to the Head of Operations and will be responsible for implementing and coordinating managed care programs which include Disease Management and Wellness Programs of the Scheme as well as ensuring efficient delivery of managed care contracts between the Scheme and its clients.
b) The Managed Care Programs Manager will also serve as a key liaison officer between the Scheme and its Third (3rd) Party Administrator as well as Managed Care and Health Risk Management Contractors, ensuring that all applicable operational processes are effective, efficient and value driving to the members and clients of the Scheme.

KEY DUTIES AND RESPONSIBILITIES

a) To design and implement managed care programs of the Scheme, ensuring they are optimally integrated to enhance product offering and to improve the Scheme’s health balance sheet.
b) To drive efficient operational activities of the Scheme’s Managed Care Programs.
c) To ensure optimal delivery and high performance of managed care contracts the Scheme has entered into. d) To act as a primary contact point between the Scheme and its Managed Care/Health Risk Management Third in Managed Care Programs.
e) To promote and maintain good relationships between the Scheme and health care providers caring for members enrolled in Managed Care Programs.
f) To continuously review the Scheme’s Managed Care and Health Risk Management interventions to ensure they are relevant, impactful and in line with clinical governance and the global health agenda.
g) To prepare monthly and quarterly Managed Care Programs reports.

 

QUALIFICATIONS

a) A Medical Degree from a recognized institution.
b) A Post graduate qualification in Public Health or related field will be an added advantage.

EXPERIENCE

a) Minimum of seven (7) years’ work experience, two (2) of which must have been in a supervisory role. b)Exposure in Managed Health Care or Clinical Risk Management is strongly desirable.

SKILLS & ATTRIBUTES

a) Clinical know-how
b) Strong customer service ethic
c) Critical thinking and problem solving skills
d) Strong communication and interpersonal skills
e) Strong managerial skills
f) Proactive and self motivated
g) Emotional maturity and intelligence
h) Strong research and analytical skills
I) Computer literacy