Background

The AVON HMO Care Coordinator is critical to achieving business objectives by ensuring that the quality of patient management is significantly enhanced and enrollee satisfaction is maximized while promoting cost effectiveness. The successful candidate’s duties include assessing, planning, implementing, monitoring and evaluating actions required to meet the client’s health and human services needed.

Objectives

• Oversee Identify, accredit, contract, train, and manage the primary care providers and medical specialists who provides services to the enrollees (members) on the company’s health insurance plans.
• Develops, coordinates, implements, and evaluates case management services to health plan enrollees/members and health care providers that contract with the HMO.
• Collaborates with other staff in evaluating placement of members in proper primary care locations, developing and adapting forms and information systems, and mediating difficult member and provider situations.
• Oversight of timely medical management, utilization management, and discharge management interventions to meet clinical targets, assure the provision of a continuum of care to enrollees.

Responsibilities

Case Management

1. Provider relationship management framework
2. Specialization mapping for referral protocols
3. Case management, weekly PA analysis and monitoring
4. Annual wellness exercise
5. Client engagements, onsite wellness and health talks
6. Clinical quality assurance
7. Case note audit
8. Tariff review
9. Provider education and compliance

Utilization Management

• Implementation of population health & utilization program (Disease management protocols)
• Pharmacy benefit management.
• Chronic disease management.
• Optical and dental benefit management.
• Population Health & Utilization Report.
• Contact center rotation.
• Provider reconciliation; Claims vetting and remedial action.
• Provider defective claims, provider education and re-education.
• Realtime decisioning of auto pending PAs
• Sharp practices, waste & provider exploits (FWA)
• Performs other duties as assigned.

Minimum Requirements

• A fully qualified Doctor with minimum 3 years clinical experience.
• A minimum of 5 years’ experience inclusive of clinical experience, in a Managed Care/HMO variety of health care settings is required.
• Must have at least 4 years of supervisory experience.
• Must be a Registered Doctor in Nigeria with a valid practicing certification.
• Works in a standard office environment. Must attend meetings, seminars and speaking engagements throughout the Country.
• Proven experience organizing and directing multiple teams and departments
• Excellent & persuasive communicator – written and oral
• Extremely versatile, dedicated to efficient productivity
• Experience in planning and leading the implementation of strategic initiatives
• Strong data analysis and reporting skills
• Discretion, display of good judgment

Additional Requirements

• Nimble business mind with a focus on developing creative solutions
• Significant experience of conflict resolution and dealing with sensitive issues
• Significant experience of working in a highly confidential environment
• High levels of personal resilience and persistence and significant level of emotional intelligence
• Experience in budget management

Qualified candidates should apply here: Application Form