We need a PR Contract Management,
Job Description
To accomplish effective contract management and network design of the providers through the implementation of the agreed providers’ strategy and framework while complying with CCHI & SAMA rules& regulations to deliver effective price & cost management and projects’ savings .In addition ,aligning with sales & marketing to continuously developing new products & services that support business development &proposition in the insurance market and achieve business profitability and expansion goals .
Contract Mangement:
- Set up the contracts’ rules and standards with all providers for the best interest of the busines
- Supervise contracting (and engage whenever necessary)new providers ,new service codes and the renewal of contracts.
- Ensuring contracts’ compliance with the regulatory, renewals and licensing requirements.
Benchmarking:
- Introduce systems for comprehensive benchmarks for frequently billed items (regional and per network )
- Develop process, reference and guidelines for items that are not benchmarked to ensure that any item can be reasonably and fairly priced whenever requested by members or other business units.
- Develop pricing models, guidelines & benchmarks for optical and other unique services
Pricing ,Discounts and Coding:
- Revamp the coding system, including the introduction of unified parent codes, and ensure cleaning up redundancy and duplication
- Implement business obligations of ICD 10-am systems
- Ensure the resolution of defaults of the invalid & duplicate service codes and overbilling.
- Develop standard discount structure , PPD rules and slabs of volume discount
Cost Effectiveness:
- Develop (and negotiate whenever necessary) price reduction plans to achieve business goals
- Develop and enhance plans to agree with the providers on services’ bundling (in & out patients) and expansion of surgical packages
- Ensure (and Negotiate whenever necessary)that the prices of new & renewed contracts and addition of new services are consistent with the benchmarks and achieving the business targets
- Provide business stakeholders with price forecasting on regular basis and whenever necessary.
Network Design and Management:
- Ensure that the network of providers is comperhensive and covering all benefits for each class.
- Enhance , regularly ,the providers network (down/up grading) based on risk cost and business requirements
- Optimize accessible and affordable network .
- Optimize optical and dental providers’ network
- Manage pharmacy benefits including networking ,formularlies and refills systems
Volume Allocation:
- Enhance stepladder referrals system with regular updates to achieve best practice and cost effectiveness.
- Develop network of anchor providers and centers of excellence
- Manage volume re-allocation of all or specific services from one provider to another whenever indicated
Service Innovation:
- Explore and Develop new payment approaches to cope with business growth like paradigm shift ,prepaid services and accountable care organization
- Explore and develop partnership relations with strategic providers
- Develop providers ,physicians and service finder for website support and development.
- Introduce healthcare plans that respond to market needs ,health & benefits and business developments.
- Develop new products and services ,e.g. Fast track ,external doctors ,special arrangement (SPA) ,High skills physicians network ,maternity and uncovered services.
Coordination and Communications:
- Ensure that addition/deletion of contracts/providers ,amendments and significant contract milestone are communicated to the operation team and technical stalkeholders.
- Communicate regular price forecast to the commercial finance
- Communicate newtwork redesign ,referral system updates to operation team and sales
- Coordinate with sales ,marketing and commercial finance volume re allocation ,healthcare plans and network updates.
People Management:
- Provide leadership ,professional guidance and directions to the assigned team members.
- Preparing and overseeing KPI for the team.
- Ensure and facilitate goal setting ;manage and constantly review individual performance
- Provide regular feedback ,coaching ,and development
- Motivate ,empower and enable direct reports by providing technical expertise , necessry tools and support required to achieve the organizational development objectives
- Build the capabilities of the team members.
Skills
- 5 – 7 years
- Bachelor in medicine and surgery
- Medical practice
- Hospital management (preferrable)
- Contracting and pricing of services
- Good knowledge on CCHI rules & regulations
DETAILS TO REGISTER FOR THIS JOB:
Make Sure Your CV is ATS-friendly.
What is an ATS CV?
Applicant Tracking System or "ATS", is the software that 'READS' your CV and stores this information in a database. Like this:
If the CV is not made as per the RULES of the ATS, the information will get messed up in the database. In the image below, 'PMP' has gone into the 'Mobile Number' column. The Mobile Number '052 1234567' has gone into the 'Main Skill' column.
So a recruiter searching for a candidate with PMP certification, will never find this person, in spite of his 'CV information' existing in the database...
...And, he will wonder why he gets rejected in spite of being a PERFECT MATCH for the Job.
Entry Level (0 - 2 Years Career Experience)
Junior Professional Level (2 - 5 Years Career Experience)
Mid Level Professional (5 - 8 Years Career Experience)
Senior Professional Level (8 - 15 Years Career Experience)
Senior Professional Advancement (15 - 25 Years Career Experience)
Industry Expert & Legacy Positioning (25 - 40 Years Career Experience)
Executive Level (C-Level, MD, VP, Director, Lawyer, Doctor, Investor, etc.)
Board & CXO Positioning (8 - 40 Years Career Experience)
Information About Leading Certifications:
http://www.dubai-forever.com/pmp.html
http://www.dubai-forever.com/shrm.html
http://www.dubai-forever.com/aws-solutions-architect.html
http://www.dubai-forever.com/az-305.html
http://www.dubai-forever.com/nebosh-igc.html
Are You Ready To Get Certified? Get a FREE Personalised Report:
https://www.dubai-forever.com/pmp-eligibility-calculator.html
http://www.dubai-forever.com/power-bi-career-readiness-calculator.html
Read the recommendations our customers have given us, on my LinkedIn profile:
https://www.linkedin.com/in/shabbirfkagalwala/details/recommendations/
Navigate here for more testimonials/feedback about our expertise and results:
www.dubai-forever.com/resume-writing-feedback.html
www.dubai-forever.com/cv-writing-reviews.html
Also, read reviews about "www.Dubai-Forever.Com" on TrustPilot.com, the world's most trusted review site...
Navigate here for the Latest CV Samples & Templates, APPROVED by recruiters. For FREE!:
Join the Fastest Growing Job Group on LinkedIn:
Join the Middle East's Best Job Groups on Whatsapp:
Join our Telegram Group:
Submit your CV here, as well:
We support the Far-Sighted, Growth-Oriented Vision announced by the UAE, Saudi Arabia, Qatar, Oman, Kuwait and Bahrain.
It's an exciting time and the next 30 - 40 years will see massive growth in jobs in the GCC countries.
Excited about working in the GCC? Click on one of the banners below...
Watch, Like, and Subscribe to the YouTube Channels:
House of Focus creates original cinematic Deep Focus Music and immersive Flow State Soundtracks™ designed for studying, coding, reading, writing, creative work, and distraction-free productivity.
https://www.youtube.com/@HouseofFocus-28Indian Folk Originals - We create original Punjabi folk-inspired wedding songs built around the biggest moments of Indian celebrations.
https://www.youtube.com/@IndianFolkOriginalsHedgehog Haven - Discover beautifully crafted, photorealistic hedgehog videos set in tranquil forests, cozy gardens, misty mornings, gentle rain, autumn leaves, snowy landscapes, and magical natural habitats from around the world.
https://www.youtube.com/@HedgehogHaven-6If you want to promote your services/products as well, get in touch with us.
SOCIAL INITIATIVE:
We publish job vacancies on this Job Portal (https://www.dubai-jobs.me) and our Whatsapp groups (www.dubai-forever.com/whatsapp-jobs.html) for the benefit of job-seekers.
It is to help people who are searching for jobs from across the world.
This is a Social Initiative from our team @ dubai-forever.com, so please help in this Noble Task by Forwarding these jobs within your Network.
Do this GOOD DEED.
You never know who will benefit from it.
You've heard about KARMA right?
It's waiting to give you 10X of whatever you do... Do the Good Deed. FORWARD NOW!
No comments:
Post a Comment