Head of Medical

Job Ref: HM-ABJ-07-26
Location: Abuja (FCT)
Employment Type: Full-time

Summary

• To answer and or/initiate customer calls, respond to customer needs in a professional, service-oriented manner and maintain the highest level of customer satisfaction by seeking first call resolution.
• Modelling effective communication skills, must be knowledgeable about the products and services of Prepaid Medicare Services Ltd HMO.

Key Responsibilities

• Developing and implementing clinical policies.
• Coordinating healthcare services across provider networks.
• Monitoring quality of care and patient outcomes.
• Participating in strategic planning and organizational decision-making.
• Overseeing health promotion and disease prevention programs.
• Managing provider relationships and accreditation.
• Supervising call nursing staff.
• Handling clinical complaints and resolving healthcare-related issues.
• Ensuring compliance with regulatory requirements.
• Reviewing treatment plans and ensuring cost-effective care.

Requirements
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills and certification required.
Educational Qualifications:

• Registered Nurse (RN) with a valid practicing license from the relevant nursing regulatory body.
• Bachelor of Nursing Science (BNSc/BSc Nursing) as the minimum qualification.
• A master's degree in Nursing, Public Health, Health Administration, Healthcare Management, or Business Administration (MBA) is often preferred for leadership roles.

Experience:

• Typically 5–10 years of post-qualification clinical experience.
• Experience in managed care, health insurance, quality assurance, utilization management, or hospital administration is highly desirable.
• At least 3–5 years in a supervisory, managerial, or leadership role.

Knowledge and Skills:

• Decision-making and problem-solving abilities.
• Excellent leadership and team management skills.
• Strong understanding of:
  • Healthcare policies and regulations.
  • Claims management and provider relations.
  • Case management and utilization review.
  • Clinical governance and quality improvement.
  • Health insurance and HMO operations.
• Financial and budget management skills.
• Competence in electronic health records (EHRs) and healthcare information systems.
• Strong communication and interpersonal skills.

Professional Certifications (Advantageous):

• Project Management certification.
• Experience in managed care, provider network management, or health insurance administration.
• Quality Improvement or Patient Safety certification.
• Good knowledge of the National Health Insurance Authority guidelines and the Nigerian healthcare system.
• Leadership and management training.
• Healthcare Management certification.
• A valid license from the Nursing and Midwifery Council of Nigeria.
• Relevant management experience.

Personal Attributes:

• Ability to work under pressure.
• Ability to build relationships with healthcare providers, clients, and regulatory agencies.
• High ethical standards and integrity.
• Strategic thinking and planning skills.
• Excellent organizational skills.
• Commitment to patient-centered care.