Head, Business Development & Managed Care - PH

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 authorization 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-authorization, referrals, and management of care within scheme terms.
• Oversee claims preparation, submission, reconciliation, and follow-up to minimize 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 processes.
• Understanding of claims, authorization, 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, authorizations and HMO/scheme relationships.
• Experience supervising staff and managing service performance.

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.