Care Coordinator

MetroHealth HMO Limited

 Lagos
Last Seen: 24th February 2021

Company NameMetroHealth HMO Limited

Job TypeFull Time


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.

We are recruiting to fill the position below:

Job Title: Care Coordinator

Location: Lagos
Employment Type: Full-time

Job 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 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

Requirements

  • 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.

Application Closing Date
7th February, 2021.


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