Medical Doctor & Quality Assurance Manager

Eagle HMO Limited, a leading Health Maintenance Organisation based in Lagos and with branches spread across the nation requires the services of a competent Medical Doctor with 5 years work experience in HMO to fill the role of Doctor/Quality Assurance Manager.

Job Decsription

• Case management of enrollee complaints, diagnosis and treatment at the provider to ensure cost-quality of care balance is maintained 
• Checking vetted claims for accuracy and correctness in line with diagnosis
• Evaluate the performance and reliability of Health Care Providers (HCP) by carrying out random spot checks on enrollees to corroborate  claims by HCPs – ratio of 1:10 spot checks monthly
• Periodic checks on activities and processes of HCPs, by QA calls, visits or surveys to HCPS
• Analyze Provider reports for management information
• Provide managed care services
• Recognize and fix weaknesses in the system
• Manage all HMOs units to deliver on their deliverables daily 
• Provide leadership and ensure that HCP meets quality checklist for onboarding
• Develop and implement necessary quality policy as guidelines for Provider manager department
• Implement quality checklist to follow to approve HCP into our network
• HCP/Enrollee Complaint escalations
• Courtesy calls on existing and prospective customers