The clinical services manager is responsible for development and implementation of medical practices at Minet aimed at providing solutions that guarantee provision of quality healthcare services to our clients, better medical outcomes and cost management. The manager will also be required to offer clinical support to the business.
Responsibilities
Develop and implement a managed care strategy thorough pre-authorization and care management processes to ensure accurate decisions on levels of care and appropriate treatment to patients.
Advise business on market trends & service feedback.
Management of Special Cases & Arbitration.
Management of ACOS & ALOS.
Manage local and abroad evacuations.
Referral to CDM Programs – Process Management.
Cost containment – Enforcement of rates, Discount negotiations, Client Advisory, Step down management, Discharge planning, Homecare management.
Call Centre Management – Effective management of the 24-hour call Centre.
Ensure seamless access to care.
Professional, accurate and timely responses to clients.
Attend to customer feedback/complaints.
Timely escalation and reporting of any incidences.
Enhance Customer Experience – Establish and maintain good relationships with internal and external stakeholders such as Health care service providers, Insurers, Contracted suppliers etc.
Preparation of relevant Management /Business Reports – Provide leadership in utilization of clinical and claims data to develop innovative products and processes that provide competitive advantage.
Guiding the business in compliance to health regulations relating to health insurance.
Provide leadership, coaching, mentorship and motivation to the direct reports and their teams.
Qualifications
A Bachelor’s degree in health-related course with over five (5) years in Health insurance.
Operations in a managerial role and experience in managing a team will be an added advantage.
Job competencies
Leadership and People management skills.
Strong Negotiation skills.
Decision making skills.
Adaptive and ability to work under pressure.
