Coordinator, Managed Care Services (Business Development & Managed Care)

About the role

• To lead the hospital's managed-care function, owning the interface with HMOs and retainership schemes, and ensuring enrolee service, claims and authorisation processes deliver both quality care and commercial sustainability.

Responsibilities

• Direct the hospital's managed-care operations and manage relationships with HMO and retainership partners.
• Oversee enrolee verification, pre-authorisation, referrals and management of care 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.
• Track managed-care performance and revenue, and report findings with improvement recommendations.
• Champion enrolee experience, complaints resolution and retention across the function.

Required skills

• Strong knowledge of managed-care, HMO and retainership processesUnderstanding of claims, authorisation and revenue-cycle management
• Ability to align clinical and commercial requirements
• Ability to lead, coach and develop a team
• Strong communication, negotiation and analytical skills
• Working knowledge of managed-care/claims systems and performance reporting

Experience

• 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. Role-specific:
• Experience working at the interface of clinical and commercial functions in a healthcare setting.

Education

• 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.