Medical Provider Management Manager

Job Purpose:

The Manager - Medical Provider Management will support the development, implementation, and management of medical provider networks. Reporting to the Senior Manager or Head of Department, this role focuses on ensuring the quality, cost-effectiveness, and accessibility of healthcare services provided to members. The Manager will negotiate with providers, maintain provider relationships, and collaborate with various departments to optimize network performance. The incumbent is expected to negotiate strategically with the Medical Providers with an objective to procure Medical Services at an optimized cost and to generate revenue through effective applicable various revenue streams and execution of identified revenue generation strategies. The candidate should be able to factually demonstrate the cost savings and to maintain strong Medical Provider relationships.

What you do:

Responsibilities will include, but are not limited to, the following:

Strategy:
- Support and drive the strategy devised by the MPM Management
- Develop cost savings strategies aligned with financial savings target, this is to be delivered by the team but also individually
- Network Development: Develop and maintain a robust network of healthcare providers, including hospitals, physicians, diagnostics and ancillary services.
- Provider Contracting: Negotiations with healthcare providers to secure favorable terms and conditions, ensuring cost-effective care and robust applicable provider revenues.
- Provider Relations: Establish and maintain positive relationships with network providers, addressing any concerns or issues promptly and escalating as needed.

Compliance:
- Ensure Provider network and contract management comply with all relevant internal and external regulations, local mandates, accreditation standards, and organizational policies. Responsible for compliance of TOM and DTP ' s
- Performance Monitoring: Monitor network performance metrics, including cost, quality, and accessibility/segmentation, and implement improvement initiatives as needed.
- Team Collaboration: Work collaboratively with the MPM team providing support, coaching, assistance and guidance to achieve organizational objectives.

Collaboration:
- Work closely with other departments such as Claims, Business development, CRM, Operations and Finance to support overall organizational goals.

Reporting:
- Prepare and present regular reports on network performance to senior leadership
- Uses judgment, diplomacy and confidentiality with respect to the complete procurement process, ensuring integrity.
- Withholds the reputation of the company, beneficiaries, payers and all other parties involved.
- Responsible to follow the Local & Regional DOAP (Delegation of Authority Policy)

Provider Training material :
- Plan Provider training per requirement and maintain updated training material in alignment with local market practices

Requirements: