Job Vacancy: Medical Operations Manager (Uganda)
Purpose of the Position: To ensure that the medical claim process (from seeking healthcare to payment) is efficient and effective to enable the company achieve the desired loss ratio while adhering to the agreed SLAs.
To ensure that clients receive quality healthcare from the right providers at the right time and price.
Key Performance Areas:
- Management of desired loss ratio
- The prescribed SLAs for accessing care
- Ensure good relationship with medical providers
- Review of processes constantly to ensure optimal efficiency
- Staff management – Care Management, Claims department and Medical Providers Department
- Ensure quality care for both Members /non-Client through Care / Case Management.
- Package and Market Care / Case Management.
- Analysis and Comment on Hospitalization Reports.
- Identify and Negotiate with International Provider / Assistance.
- Co-ordinate Evacuations within E.Africa for member / non-member.
- Chair department / Service meetings.
Duties Include:
- Medical Advisor to Senior Management, budgeting, strategy, product development, restructuring, underwriting and other departments through several meetings, reports etc based on current hospitalization trends
- Help in coming up with Hospitalization parameters and strategies of how to achieve them
- Assist Sales staff in Business acquisition and retention
- Chair of Hospitalization and Provider Accreditation teams
- Member of Underwriting Committee
- Member of Health Promotion team
- Direct Management of Hospitalization Parameters i.e. Average Length of Stay, Average cost of care, hospitalization rate, SLA adherence
- Take part in identifying and managing Medical Providers
- Responsible for all Outpatient and In Patient Approvals
- Take part in selecting/interviewing of new staff members
- Training of staff in Claims, Care Management and Providers departments in underwriting and claims management whilst adhering to policies and guidelines given by the company
- Management and evaluation of day to day tasks carried out by different staff members in the department
- Responding to customer queries.
Key Performance Measures:
- Average Length of stay
- Average cost/case – IP, OP
- Hospitalization rate
- BSC – personal and team
- SLAs
Level of Education & Experience:
- Bachelor of Medicine (MUST be a certified Medical Doctor).
- At least 5 years relevant working experience.
- Knowledge and experience in Health Care Management, preferably in an insurance company.
Other Competencies:
- Leadership skills
- Communication skills
- Self starter, requiring minimal supervision
- ICT competency
All applicants should indicate the position on the subject line and forward all the applications to recruitment@careerdirections.co.ke by December 15 2015.