Vacancies in a Leading NHIS Accredited National Health Maintenance Organization

A reputable dynamic and leading NHIS accredited National Health Maintenance Organization with its Headquarters situated in Abuja is in need of the services of a result-oriented, proactive, knowledgeable and diligent individual to fill the position below:

Job Title: Head, Medical & Quality Assurance Department

Location: Abuja

Background

• We are looking for an experienced Medical Doctor with strong administrative skills to Manage and run our Medical and Quality Assurance Department.
• To be successfulin this role, you should have a deep understanding of all administrative process and procedure relating to the role, from developing work schedules and actively engaged/ coordinating the establishment of robust working relationship with providers and enrollees.
• He or She coordinate the budgeting, stocking and maintaining supplies of medications for our managed first aid and emergency programme.  The candidate is expected to possess   considerable knowledge of Managed Care and Health Insurance Programme.
• The candidate is expected to deploy outstanding organizational and leadership skills to drive the process and supervise/coordinate the workforce in the Department at the Head Office and across the branches for measurable performance and compliance with policies and regulations.

Duties and Responsibilities

• Coordinate and supervise the activities of the Department to ensure optimal performance;
• Ensure the smooth operation of the organization’s Telemedicine Platform.
• Monitor the activities of the Claims Unit, Providers Network Administration Unit, the Medical and Quality Assurance Department across the branches as well as the Utilization Management Unitfor quality vetting and time management in the Claims vetting process and elimination of fraud.
• Oversee thesupplies and management of medications for our first aid / emergency services across the nation.
• Maintains a cordial working relationship among team members through effect disseminationof information, timely response to issues from critical stakeholders, buildingbridges and participating in team crisis management methods.
• Coordinate and oversee standard filing processand recordskeeping as it relates to all the activities in the Department.
• Review all pre-authorization approvals given by the Utilization Management Officers in the Call Center to ensure the genuineness of all approvals.
• Ensuresquality health care delivery to enrolees by continuous monitoring and evaluation of healthcare facilities activities.

Qualifications and Experience
Education:

• Applicant must possess a Medical Degree (MBBS)
• Up-to-date registration and license from the MDCN
• Post-Graduate Medical and Dental qualification, Certification by WACP or equivalent body or Specialist training in a chosen area of medicine are added advantages.

Experience:

• Applicant must have minimum of between 10 to 12-years Post NYSC experience.
• Minimum of 5 years’ experience working in a similar role.
• Experience in the usage of computers and other relevant software packages is desirable.

Language Requirements:

• Fluency in Oral and written English is a requirement.

Job Title: Head, Claims Management Unit

Location: Abuja

Background

• The Head of Claims Unit will oversee the handling of all claims in line with the approved NHIS Drug and Service tariffs for payment to secondary/tertiary healthcare providers that render services on referrals from other accredited healthcare providers.
• These functions are performed under the immediate supervision of the Head, Medical & Quality Assurance Department and would also be required to serve in an acting capacity when the Head of Medical Department is not available.

Duties and Responsibilities

• Coordinate and supervise the activities of the Unit to ensure optimal performance;
• Coordinate and handle the collation, entry and analysis/reporting of encounter returns from hospitals
• Analyze data for bill presentation based on requirements and review claims for quality and elimination of fraud
• Maintains supplies inventory for our train operations by checking stock to determine inventory level; anticipating needed supplies; placing and expediting orders for supplies; verifying receipt of supplies; using equipment and supplies as needed to accomplish results
• Maintains a cooperative relationship among team members by communicating information, responding to requests, building rapport and participating in team problem-solving methods
• Coordinate and oversee maintaining of records as it relates to all the activities in the Unit.
• Stays up to date on regulations, and implements changes regarding claims and billing requirements
• Ensures quality health care delivery to enrollees by continuous monitoring and evaluation of healthcare facilities.
• All other duties that might be assigned by reason of the position.

Qualifications
Education:

• Registered Professional Nurse and a first-level degree from an accredited Baccalaureate Nursing Programme (University) or equivalent.
• National registration and licensing are required.
• Recognized additional training in primary health care and midwifery is desirable;

Experience:

• Minimum 3 years of continuous Claims Management experience;
• Experience in the usage of computers and other relevant software packages is desirable.

Language Requirements:

• Fluency in oral and written English is a requirement.

Competencies:
Professionalism:

• Knowledge and experience in Claims Management.

Communication:

• Ability to write in a clear and concise manner and to communicate effectively orally.

Teamwork:

• Good interpersonal skills; ability to work in a multi-cultural, multi-ethnic environment with sensitivity and respect for diversity.
• Establishes, build and sustain effective relationships within the work unit.

Planning and Organizing:

• Develops clear goals that are consistent with agreed strategies;
• Ability to establish priorities and to plan and coordinate own work plan;
• Allocates appropriate amount of time and resources for completing work;
• Foresees risks and allows for contingencies when planning;
• Monitors and adjusts plans and actions as necessary; uses time efficiently.
• Organizes and prioritizes work schedule to meet deadlines.

Technological Awareness:

• Proficiency in relevant medical software packages.

Commitment to Continuous Learning:

• Initiative and willingness to keep abreast of new skills in the field.

Deadline: 26th November, 2020.

Method of Application
Interested and qualified candidates should send their CV to: ourrecruitment017@gmail.com using the “Job Title” as the subject of the email.

Note: Only shortlisted candidates will be contacted and advance to the next stage of the selection process.