Qualifications, Skills and Experience Required:

• Fifteen 15 years of cumulative service period of relevant work experience, with at least three 3 years at Assistant Director, Provider Management or comparable.
• Bachelor’s Degree in Commerce, Accounting, Business Administration, Finance or Economics, Business, Medicine, Social Science, or Pharmacy equivalent qualification from a recognized institution.
• Master’s Degree in Strategic Management, Finance, Business Administration or equivalent qualification from a recognized institution.
• Member of the relevant professional body where applicable and in good standing.
• Certificate in Leadership Course lasting not less than four 4 weeks from a recognized institution.
• A valid practicing license where applicable from a recognized institution.
• Proficiency in computer applications.
• Demonstrated merit and ability as reflected in work performance and results.

Responsibilities:

Job Purpose:

 This cadre is responsible for supporting adherence to and public awareness of referral guidelines and the Empanelment of healthcare providers, ensuring they operate in line with established industry and professional standards.

Functions: 

• Enforcement of compliance with SHI ACT, related legislation and policies on beneficiary and provider management.
• Coordinating the development, implementation, monitoring, and reviewing of sustainable operational strategies relating to beneficiary, provider, and stakeholders’ management.
• Liaising with Strategy and Planning function in the development, implementation, and review of SHA policies relating to beneficiary, provider, and stakeholders’ management.
• Engaging with stakeholders in the Public, Private, and Sponsored Programs Sectors towards attainment of Universal Health Coverage.
• Providing technical advice to the CEO and Board of Management on issues pertaining to beneficiary, provider, and stakeholders’ management.
• Coordinating the development and implementation of strategies and policies to enhance beneficiary, provider, and stakeholders management.
• Coordinating the development and implementation of strategies for enhancing increased geographical access to healthcare services.
• Coordinating the implementation of quality improvement strategies and policies in empanelled health care facilities.
• Resolving complaints from both Beneficiaries and Providers.
• Production and dissemination of all monitoring and evaluation reports including statistical reports for beneficiary and Provider Management.
• Establishing, maintaining, and updating quality assurance systems in accordance with International Best Practices.
• Collecting, analyzing, monitoring, and controlling reports from contracted health facilities.
• Administering contracts, including preparing, signing, reviewing, adjustment, and payment based on performance reports.
• Coordinating the Performance Contracting process.
• Defining standard operating procedures for the implementation of performance-based contracting, including contract performance monitoring, performance verification, payments, sanctions, grievance redress, and contract renewal and modification.
• Overseeing empanelment of healthcare providers and ensuring they are operating in line with the set industry and professional standards.