MacTay Consulting is one of the leading management consulting firm with a track record of providing excellent HR services to their clients in Africa since 1982. They specialize in providing Training and HR Consulting Services, Outsourcing, and Staff Management Services and Digital Solutions.
JOB TITLE: Head Medical Operations and Quality Assurance
- The Head, Operations will oversee key functions (such as: Healthcare Provider Accreditation and Contracting, claims management, Complaints resolutions, Authorizations) which are aimed at providing quality healthcare services to members.
- Develop Strategies, Policies and Plans for ensuring access to quality healthcare services including Quality Improvement Plans
- Provide technical input for costing and actuarial analysis.
- Establish mechanisms for reducing provider and enrolee moral hazards.
- Advice Management on present and future operational requirements and risks; proffer solutions for mitigating risks. ▪ Provide periodic reports across units in the department
- Perform other strategic functions assigned by the Board.
- Define Service standards and develop Service Level Agreements with
- HCPs and contracted parties
- Develop and periodically review tariffs for services.
- Monitoring of Utilizations & Medical Loss Rations (MLR)
- Review and approve Panel lists and Claims.
- Oversee referral activities and high-cost treatments.
- Oversee the 24hours call centre operations.
- Drive Operational efficiency and cost optimization.
- Accredit and re-accredit all levels of HCPs
- Oversee conduct of Clinical Audits and verification exercises on services delivered.
- Manage stakeholders involved in service delivery to ensure services.
- Meet with agreed standards defined in the Service Level Agreements
- Foster cordial relationships with clients, healthcare providers, and other stakeholders
- Ensure implementation of appropriate sanctions for erring stakeholders/Players.
- Provide leadership and direction for Operations department.
- Manage performance, mentor, and coach team.
- Minimum of a Bachelor’s Degree or equivalent in Medicine, Pharmacy, or other health-related disciplines
- Postgraduate degree in Public Health, Health Administration, & Management, Health Economics, or a related degree will be an added advantage.
- Minimum of 10 years experience with at least five years in a managerial capacity
- Experience in handling the Operations of a health insurance institution is mandatory.
Interested and eligible applicants should send their detailed CV (not more than 3pages) to email@example.com using the Job Title as the subject of the email.
Deadline: 15th of February, 2021.
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