Head of Medical

Job title : Head of Medical

Summary

• To answer and or/initiate customer calls, respond to customer needs in a professional, service-oriented manner and maintain the highest level of customer satisfaction by seeking first call resolution.
• Modelling effective communication skills, must be knowledgeable about the products and services of Prepaid Medicare Services Ltd HMO.

Key Responsibilities

• Supervising call nursing staff.
• Coordinating healthcare services across provider networks.
• Monitoring quality of care and patient outcomes.
• Reviewing treatment plans and ensuring cost-effective care.
• Developing and implementing clinical policies.
• Managing provider relationships and accreditation.
• Ensuring compliance with regulatory requirements.
• Participating in strategic planning and organizational decision-making.
• Handling clinical complaints and resolving healthcare-related issues.
• Overseeing health promotion and disease prevention programs.

Requirements
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills and certification required.
Educational Qualifications:

• Registered Nurse (RN) with a valid practicing license from the relevant nursing regulatory body.
• Bachelor of Nursing Science (BNSc/BSc Nursing) as the minimum qualification.
• A master's degree in Nursing, Public Health, Health Administration, Healthcare Management, or Business Administration (MBA) is often preferred for leadership roles.

Experience:

• Typically 5–10 years of post-qualification clinical experience.
• At least 3–5 years in a supervisory, managerial, or leadership role.
• Experience in managed care, health insurance, quality assurance, utilization management, or hospital administration is highly desirable.

Knowledge and Skills:

• Strong understanding of:
  • Health insurance and HMO operations.
  • Clinical governance and quality improvement.
  • Healthcare policies and regulations.
  • Case management and utilization review.
  • Claims management and provider relations.
• Excellent leadership and team management skills.
• Strong communication and interpersonal skills.
• Decision-making and problem-solving abilities.
• Financial and budget management skills.
• Competence in electronic health records (EHRs) and healthcare information systems.

Professional Certifications (Advantageous):

• Healthcare Management certification.
• Project Management certification.
• Quality Improvement or Patient Safety certification.
• Leadership and management training.
• A valid license from the Nursing and Midwifery Council of Nigeria.
• Relevant management experience.
• Good knowledge of the National Health Insurance Authority guidelines and the Nigerian healthcare system.
• Experience in managed care, provider network management, or health insurance administration.

Personal Attributes:

• High ethical standards and integrity.
• Ability to work under pressure.
• Strategic thinking and planning skills.
• Excellent organizational skills.
• Commitment to patient-centered care.
• Ability to build relationships with healthcare providers, clients, and regulatory agencies.