Care Coordinator Vacancy at Metro Health HMO Limited

About the role

Care Coordinator job opportunity is available at Metro Health HMO Limited for individuals who possess relevant qualifications.

Responsibilities

• Educate providers on new systems, processes and procedures in managed care and health insurance.
• Provider engagements via visits and phone calls for necessary updates and follow up
• Coordinate, track and monitor the administration of exclusions and to ensure prompt payments by all parties and payment to the providers.
• Notify providers of changes in HMO operational modalities.
• Monitor and coordinate care of the enrollees and ensure care coordination within and outside of network
• Prepare and provide case note audits, report and recommend improvement
• Carry out onsite investigation of complaints with a view to resolving them.
• Investigate critical incident and reviewing outcome of results
• Handle grievance and complaints from all stakeholders – enrollees, clients and providers
• Coordinate emergency out of network care and enrollee referrals.
• Development and implementation of patient care policies and protocols
• Managing the implementation of the Medicloud technology platform as it relates to providers, and contributing to the website content and implementation with Medical and non-medical interventions.
• Provider Relations
• Performance Indicators: Turnaround time for issuing, Pre-authorization., Reduce denial of care to enrollees, Low Medical cost
• Provider enlightenment activity report
• Medical records review
• Provider satisfaction survey report
• Provider satisfaction reviews
• Provider termination & disengagement reviews
• Provider report carding & incentivizing reports
• Network adequacy assessment report
• Provider accessibility and availability report
• Case management reports
• Credentialing review
• Credentialing report
• Provider contracting report.
• Organizational process mapping
• Administrative process review (filing system audit, system fee schedule audits, system benefit and premium audit)
• Client and provider contract reviews

Marketing:
Work with cross functional teams in order to generate new business. This will involve:

• Carrying out presentations
• Participation in Preventive Health programmes and Community Outreach events

Utilization:

• Comprehensive utilization management and control through preauthorization review and case management analysis.
• Utilization Management and Evaluation reports
• Case management of all Pre-authorizations, enrollee visits and enrollee call back.
• Enrolee refund investigation and reviews
• Provider appeal reviews
• Proactive review of pre-authorization/encounter data to determine discrepancies, trends and opportunities for disease management and allied medical and interventions.
• Ensure improvement in medical cost management with reduction in medical loss ratio
• Performance Indicators: Enrolee complaint rate, Provider complaint rate, Enrolee & provider successful appeals ratio

Service Quality Improvement:

• Administrative process review (filing system audit, system fee schedule audits, system benefit and premium audit)
• Client and provider contract reviews
• Maintenance of a dashboard of available skills and equipment within the provider network
• Perform all other functions as may be assigned from time to time
• Performance Indicators:  Registration error rate

Experience and qualifications

• MBBS
• Minimum of 10 years post NYSC experience in clinical practices
• Valid practitioners license
• Fully qualified and registered with Medical and Dental Council of Nigeria
• Effective time management, communication and organizational skills.
• Previous experience of working in an HMO.

Skills:

• Effective communication and Reporting skill.
• Proficiency in use of Microsoft office applications

Application deadline

22nd January, 2021.

WHO IS Metro Health HMO Limited?

MetroHealth HMO is a Nigerian leading health management organization with an aim to render unparalleled technology-based and comprehensive primary, secondary, and tertiary health care services across the country. MetroHealth was registered by the regulatory authority, the National Health Insurance Scheme (NHIS) to operate as a national HMO in 2013.

With over 650 partner hospitals, we are committed to rendering world-class preventive and curative health care services to our clients in the easiest and stress-free method. We understand that every client is unique and deserves flexible, specialized solutions; therefore we embrace an individualized approach towards taking excellent care of our clients.

We are big on maximizing the blessings of technology to render 21st century-based health services making sure our clients are in the best state of health.