Provider Network Officer

Key Responsibilities and Accountabilities

• Sign up providers across the region.
• Provider selection and management: enlisting, negotiating, delisting, rewarding, training, and enlightening providers on the network.
• Working with other provider network managers in the region to develop the provider network
• Tariff negotiation and review
• Contract and SLA management
• Scheduling major and highly specialized patient procedures
• Referral and monitoring of complex cases
• Utilization Review Management
• Encounter data analysis
• Providers audit and quality assurance: this involves infrastructure audit, compliance and service quality
• Review of care delivery protocols
• Analysis of hospitals tiers and capability
• Quality assurance reports on providers to ensure compliance without compromising quality
• Provider complaint escalation and resolution.
• Cost control and cost containment.
• Ensuring healthy and mutually beneficial relationships between Bastion Health and providers
• Coordination of emergency cases

Key Performance Indicators

• Hospital spread—Lagos and southwest
• Provider satisfaction index
• Customer satisfaction index
• Average encounter per member per provider
• Average length of stay in the hospital
• Average cost per encounter
• Claims ratio

Job Requirements

• BSN from a certified university/RN from a certified Nursing College
• 2 years of experience as a medical doctor.
• HMO experience will be an added advantage.
• Explicit understanding of Medical Cases and Terminologies