Coordinator, Managed Care Services (Delta)
a Growing Multi-specialist Healthcare Group - Dragnet Solutions Limited
About the role
- To lead the hospital's managed-care function, owning the interface with HMOs and retainership schemes, and ensuring enrolee service, claims, and authorisation 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 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.
Requirements
Education:
- 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.
- Postgraduate qualification or certification in managed care, health insurance, health administration or management is desirable.
Experience:
- Minimum of 8 years of relevant experience in managed care, HMO liaison or healthcare administration, including supervisory experience.
- Substantial experience in managed care, health insurance, HMO operations or hospital revenue-cycle management.
- Experience coordinating claims, authorisations and HMO/scheme relationships.
- Experience supervising staff and managing service performance.
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.
Application Closing Date
6th October, 2026.
How to Apply
Interested and qualified candidates should:
Click here to apply online
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Vacancy posted 4 days ago
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