الصفحة الرئيسية قطر Senior Network Manager - Medical Department
الصفحة الرئيسية قطر Senior Network Manager - Medical Department
Senior Network Manager - Medical Department
تفاصيل الوظيفة
Job PurposeQLM is hiring for its Medical Department, this role will consist of building, scaling, and continuously improving the medical network, supporting various key departments in KPI development and tracking for medical providers. Responsibilities of this position include the development of the QLM's provider network strategy, provider contracting, provider relations and operations to support provider service, network development, provider education, and product and market expansions.The candidate will be reporting to the Chief Medical Officer, the ideal candidate will have a strong understanding of medical insurance, Insurance policies, claims management cycle, healthcare providers & vendor contracting. He or she will be responsible for overseeing medical provider relations, negotiating contracts, and ensuring network growth and efficiency.Key Responsibilities:• Establish excellent relationships with providers, assess their integration & empanelment to QLM's network by comparing their prices to contracted providers within the network, taking into consideration the providers' location and the geographic distribution of the members.• Liaise with network providers to resolve issues and complaints stemming from customer service, and maintain a performance log against healthcare providers.• Conduct reconciliation meetings with the providers, this will include scheduling meetings and coordination with the medical claims team to ensure all reconciliations are undertaken with accurate information and concluded on time.• Assess and evaluate, on an ongoing basis, the quality of services delivered by the providers to ensure that the members are receiving the best healthcare.• Manage the delivery of training sessions and development programs to providers' staff on QLM's systems, policies, and procedures.• Ensure that the agreed terms are properly implemented, monitored and documented.• Ensure Proper Mapping of ICD (CM-AM), CPT, CDA, among all International and Local codes.• Manage network behavior through analytical methods - doctor profiling analysis, service-level behaviour, and trends within each provider.• Conduct regular impact analysis to ensure accurate price valuations and underwriting in negotiations.• Ensure all signed agreements adhere to local, regulatory & corporate outsourcing guidelines and requirements.• Maintain relationships with key healthcare providers, TPAs, and international TPAs• Ensure Letter of Guarantee (LOG) processes are adhered to by the providers.• Develop and expand Medical Network to meet ever-growing customers' needs and demands.• Negotiate with potential Medical Specialists for cashless facility and preferential outpatient, inpatient and surgical fees.• Conduct annual due diligence assessments on appointed TPAs according to local regulatory guidelines and requirements.• Monitor and ensure business efficiency and appointed TPAs' Service Level Agreements (SLAs) are met.• Provide complaints resolution in relation to service delivery failure, claims, and payment issues with Medical Providers, TPAs etc.• Analyze hospitals and panel Specialists' utilization data to develop appropriate strategic measures to manage and contain escalating medical costs.• Maintain an accurate Score Card and accurately Re-Categorize the medical network on a monthly basis.• Continuously maintain KYC standards and standardize providers contracts.• Analyze all providers codes pricing and ensure accuracy via re-negotiations to ensure QLM's rates are the most favourable in the market.• Maintain provider's average cost, accuracy of prescriptions/services and coding by continuous monitoring and deploying appropriate counter measures.• Any additional task as assigned by the pillar head for any additional projects.Qualifications and Experience:• 5 - 7 years' experience working in an Insurance company, within the capacity of a Network senior.• Bachelor degree in finance, business administration or any related field• Highly proficient in drafting, reading and writing Arabic & English• High technical skill in Microsoft Suite programs (Word, Excel, Powerpoint)• Experience of working in a regulated entity highly preferred.• Proven ability to manage work flows effectively in a multi-stakeholder environment.• Professional qualifications are preferredAbout QLM:QLM is the leading Life & Medical insurance company in the State of Qatar, aiming to provide ultimate healthcare insurance solutions, in line with the Qatar 2030 Vision. Encompassing excellence in medical standards and innovative technologies, tailor-crafted to meet member's needs both locally and internationally. Our goal is to be recognized by our partners, providers, clients and stakeholders as the preferred, trusted, long term insurer, delivering a world-class service.
#J-18808-Ljbffr Healthcare
Apply safely
To stay safe in your job search, information on common scams and to get free expert advice, we recommend that you visit SAFERjobs, a non-profit, joint industry and law enforcement organization working to combat job scams.
الشركة المعلنة عن الوظيفة
Confidential
-
Cyber Security Complete Bundle Apex Learning75 درهم
1,396 درهممدة الدورة التدريبية: Upto 3 Hours -
Learn Ethical Hacking From A-Z Course Central84 درهم
525 درهممدة الدورة التدريبية: Upto 11 Hours
Similiar Jobs that might interest you
... Senior Crisis Management Officer ... Management with 8+ years of experience in Emergency response and crisis management ...
Qatar - Doha 24 أيام مضت
... Senior Crisis Management Officer ... Management with 8+ years of experience in Emergency response and crisis management ...
Qatar - Doha 24 أيام مضت
Senior Crisis Management Officer, Qatar
NES Fircroft... Senior Crisis Management officer for its growing operations in Qatar. As a Senior Crisis Management Officer ...
Qatar - Doha 24 أيام مضت
Senior Specialist - Manager
NES Fircroft... Senior Specialist - Category Manager ... Key Roles & Responsibilities Leadership & Management 1. Lead ... than 80 offices in 45 ...
Qatar - Doha 24 أيام مضت
Senior Crisis Management Officer
NES Fircroft... the field of Emergency Response / Crisis Management with preferred experience ... With more than 80 offices in 45 countries, ...
قطر 24 أيام مضت
Senior Safety Officer
NES Fircroft... :- Senior Safety Officer Job Location :- ... responsibility and can Act as Facilitator for Safety Incident Management ...
Qatar - Doha 24 أيام مضت
Senior Loss Prevention Engineer (S-1112)
NES FircroftSenior Loss ... Escape, Evacuation, Mustering and Emergency Response. o Developing ... more than 80 offices in 45 countries ...
قطر 24 أيام مضت
Senior Systems Analyst â
NES Fircroft... for Senior Systems Analyst ... , facilities, management, reliability, ... Ensures responsibility ... and emerging ... 80 offices ...
Qatar - Doha 24 أيام مضت
Senior Analyst â
NES Fircroft... benefits. Position: - Senior Analyst - Cyber ... including incident management procedures. ⢠Deliver ... than 80 offices in 45 ...
Qatar - Doha 24 أيام مضت
Senior Project Engineer
NES FircroftSenior Project ... change and risk management processes and manages various project ... more than 80 offices in 45 countries, ...
قطر 24 أيام مضت
... Responsibilities: 1 ... in organizational management. 3. Enterprise Architecture ... current and emerging technologies. Bachelor' ...
Qatar - Doha 24 أيام مضت
Senior Loss Prevention & Risk Engineer
NES Fircroft... updated resume. Designation :- Senior Loss Prevention & ... and Emergency Preparedness. Sound knowledge of Microsoft Office, ...
Qatar - Doha 24 أيام مضت
Senior Safety Officer - Onshore Operations
NES Fircroft... hiring for an experienced Senior Safety Officer - Onshore Operations for ... . With more than 80 offices in 45 countries, we ...
Qatar - Doha 24 أيام مضت
Senior Specialist - Dive Safety
NES Fircroft... Senior Specialist - Dive Safety. The incumbent will be responsible for the below responsibilities ... Manager ... site, office, ...
Qatar - Doha 24 أيام مضت
Senior Telecom Engineer
NES Fircroft... continuity management principles Job Purpose This Senior ... substantial personal responsibility and ... than 80 offices in 45 ...
Qatar - Doha 24 أيام مضت
Senior Mechanical Package Engineer
PETROPLAN... Senior Mechanical Package Engineer ... responsible for leading, coordinating, supporting, providing expertise and management ...
Qatar - Doha 24 أيام مضت
Senior Inspection Engineer
NES Fircroft... Senior Inspection Engineer Job ... re-occurrence. Manage inspection contracts. ... more than 80 offices in 45 countries ...
Qatar - Doha 24 أيام مضت
Senior Analyst â
NES Fircroft... benefits. Position: - Senior Analyst - ... a technology management IT ... current and emerging information ... than 80 offices in 45 ...
Qatar - Doha 24 أيام مضت
Senior Architectural Engineer
PETROPLAN... Responsibilities: Lead the design and ... . Oversee multiple engineering projects, managing time, cost, and quality ...
Qatar - Doha 24 أيام مضت
لماذا تقوم بالإبلاغ عن هذه الوظيفة؟
Job has expired لا يمكن عرض هذه الصفحةبدلًا من ذلك، يمكنك النقر على الرابط أدناه أو نسخ/لصق الرابط في متصفح الإنترنت الخاص بك.
https://en-qa.whatjobs.com/coopob__cpl___2027_149027__2204?utm_source=2204&utm_medium=feed&keyword=Senior-Network-Manager&location=Doha&geoID=13