MetroHealth HMO Ltd is seeking a highly experienced and competent Medical Manager to join our team.
Job Summary
The Medical Manager will oversee clinical operations, provider network management, claims adjudication oversight, case management, and ensure quality healthcare service delivery in line with regulatory and organizational standards.
Requirements
Must be a qualified Medical Doctor (MBBS/MBChB) with a valid practicing license
Minimum of 5 years' relevant experience in the Health Maintenance Organization (HMO) space
Strong knowledge of healthcare management, utilization review, and provider relationship management
Sound understanding of NHIA regulations and healthcare quality standards
Strong analytical, leadership, and decision-making skills
Excellent communication and stakeholder management abilities
Proficiency in healthcare data analysis and reporting
Key Responsibilities
Oversee medical operations and clinical service delivery
Manage provider network performance and relationships
Review and authorize medical claims where necessary
Ensure compliance with regulatory and internal clinical standards
Drive quality assurance initiatives and cost-effective healthcare delivery
Provide medical advisory support to management
Only candidates with proven HMO experience and who are qualified Medical Doctors will be considered