Head, Business Development & Managed Care - Port Harcourt At Dragnet Nigeria

About the role

• To lead the hospital's managed-care function, owning the interface with HMOs and retainership schemes, and ensuring enrollee 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 enrollee verification, pre-authorisation, referrals and management of care within scheme terms.
• Oversee claims preparation, submission, reconciliation and follow-up to minimise 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 enrollee experience, complaints resolution and retention across the function.

Requirements

• 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.
• Minimum of 8 years of relevant experience in managed care, HMO liaison or healthcare administration, including supervisory experience.

Required skills:

• Strong knowledge of managed-care, HMO and retainership processes.
• Understanding of claims, authorisation 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.