Provider Manager (HMO)

Job title : Provider Manager (HMO)

Department: Provider Management / Operations
Reports to: Head of Provider Management

Job Purpose

• The Provider Manager is responsible for developing, managing, and maintaining a high-quality network of healthcare providers (hospitals, clinics, diagnostic centers, pharmacies, and specialists) within Benin City and surrounding areas in Edo State.
• The role ensures that enrollees of the HMO receive accessible, quality, and cost-effective healthcare services while maintaining strong provider relationships, regulatory compliance, and operational efficiency.

Key Responsibilities
Provider Network Development & Management:

• Identify, recruit, and onboard new healthcare providers to expand and strengthen the HMO’s provider network in Benin and Edo State.
• Conduct facility assessments and due diligence visits to evaluate capacity, quality standards, and suitability.
• Negotiate and manage provider service agreements, tariffs, and service-level agreements (SLAs).
• Maintain an up-to-date provider directory and ensure accurate mapping of facilities on the HMO’s systems.

Relationship Management:

• Serve as the primary point of contact between the HMO and healthcare providers in the region.
• Build and sustain strong, professional relationships with hospital management, medical directors, and key clinical staff.
• Conduct regular provider engagement meetings, feedback sessions, and performance reviews.
• Resolve provider-related issues, complaints, and disputes promptly and professionally.

Quality Assurance & Compliance:

• Monitor provider performance against agreed quality metrics, clinical standards, and HMO guidelines.
• Ensure all providers comply with National Health Insurance Authority (NHIA) requirements and internal HMO policies.
• Coordinate provider credentialing, re-credentialing, and continuous quality improvement activities.
• Conduct periodic audits and facility inspections to ensure standards are maintained.

Claims & Operational Support:

• Work closely with the Claims and Authorization teams to address claim-related queries and reduce rejections.
• Facilitate smooth authorization processes and ensure providers understand the HMO’s clinical guidelines and benefit packages.
• Support the resolution of enrollee complaints related to provider service delivery.

Reporting & Analysis:

• Prepare regular reports on network performance, provider utilization, quality indicators, and expansion progress.
• Analyze provider data to identify gaps, opportunities, and areas for improvement.
• Provide insights and recommendations to management on network strategy in the Benin/Edo region.

Other Duties:

• Support regional marketing and enrollee education activities as required.
• Represent the HMO at relevant stakeholder meetings and industry events in the region.
• Perform any other related duties assigned by management.

Key Performance Indicators (KPIs)

• Growth and retention of active providers in the network
• Provider satisfaction and engagement levels
• Reduction in provider-related complaints and claim disputes
• Compliance rate of providers with quality and contractual standards
• Timely submission of accurate network reports.

Qualifications and Experience

• Bachelor’s Degree in Medicine, Nursing, Health Sciences, Business Administration, or a related field.
• A postgraduate qualification or professional certification in Healthcare Management is an added advantage.
• Minimum of 8 years’ relevant experience in healthcare, HMO operations, hospital administration, or provider relations.
• Prior experience working with Health Maintenance Organisations (HMOs) or in a managed care environment is highly preferred.
• Strong knowledge of the Nigerian healthcare system, NHIA guidelines, and provider contracting practices.
• Experience managing relationships with hospitals and healthcare facilities in Edo State or the South-South region is an advantage.
• Skills and Competencies
• Excellent relationship management and interpersonal skills
• Strong negotiation and contract management abilities
• Good analytical and problem-solving skills
• High level of integrity and professionalism
• Strong written and verbal communication skills
• Ability to work independently with minimal supervision
• Proficiency in Microsoft Office tools and healthcare information systems
• Willingness to travel within Edo State and occasionally to other locations.