About the Role
Dragnet Solutions is a dynamic Information Technology company that specializes in the design, development, and implementation of innovative people screening solutions. Since 2007, we have been at the forefront of creating and recreating objective recruitment and application management processes to meet international standards. We are currently seeking a qualified professional to join our team as the Coordinator, Managed Care Services, to lead the hospital's managed-care function, own the interface with HMOs and retainership schemes, and ensure enrolee service, claims, and authorisation processes deliver both quality care and commercial sustainability.
Key Responsibilities- Direct the hospital's managed-care operations and manage relationships with HMO and retainership partners.
- Oversee enrolee 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 enrolee experience, complaints resolution, and retention across the function.
- Minimum of 8 years of relevant experience in managed care, HMO liaison, or healthcare administration, including supervisory experience.
- A relevant first degree in health sciences, nursing, public health, business administration, or a related discipline.
- Successful completion of NYSC or a valid exemption where applicable.
- Strong knowledge of managed-care, HMO, and retainership processes with an understanding of claims and revenue-cycle management.
- Proven ability to align clinical and commercial requirements while leading and developing a high-performing team.
- Excellent communication, negotiation, and analytical skills.
- Competitive salary and performance-based incentives.
- Comprehensive health insurance coverage.
- Opportunities for professional development and career advancement.
- Collaborative and dynamic working environment in a reputable organization.