Medical Providers Management Manager

Job description / Role

Summary:

The MPM Manager will support the development, implementation, and management of medical provider networks. Reporting to the Chief Operations Officer, this role focuses on ensuring the quality, cost-effectiveness, and accessibility of healthcare services provided to members. The Manager will negotiate with providers, maintain medical provider relationships, and collaborate with various departments to optimize network performance. The incumbent is expected to negotiate strategically with the medical providers with an objective to procure medical services at an optimized cost and to generate revenue through effective applicable various revenue streams and execution of identified revenue generation strategies.

• Maintain strong and collaborative relationships with our Payers and insured clients ensuring that in partnership they deliver efficient and robust solutions in line with the business strategy.
• Ensure that the processes and procedures developed during implementation are fit for purpose and provide the optimal customer experience.
• Work with a broad range of internal stakeholders, coordinate and negotiate alongside payer needs in terms of network, services, and reports.
• Continually monitor and adapt our procedures to ensure that the Payers are at the heart of all of our transactions.
• Improve procedures and systems where appropriate to make interactions between support the BD Manager in evaluating performance (including monthly reports, quarterly reviews, and quality audits).
• Monthly meetings with Payers to present business portfolio overview update.
• Joint meetings with Payers sales team to existing and new clients to present Nextcare services.
• Respond to all day-to-day incoming queries from Payers and clients, intermediaries effectively build strong working relationships with our Payers and clients.
• Support and train other team members depending on experience and knowledge.

Main Tasks:

• Strategy: Support and drive the strategy devised by the MPM Management. Develop cost savings strategies aligned with financial savings target, this is to be delivered by the team but also individually.
• Network Development: Develop and maintain a robust network of healthcare providers, including hospitals, physicians, diagnostics, and ancillary services.
• Medical Provider Contracting: Negotiations with healthcare providers to secure favorable terms and conditions, ensuring cost-effective care and robust applicable provider revenues.
• Medical Provider Relations: Establish and maintain positive relationships with network providers, addressing any concerns or issues promptly and escalating as needed.
• Compliance: Ensure medical provider network and contract management comply with all relevant internal and external regulations, local mandates, accreditation standards, and organizational policies. Responsible for compliance of TOM and DTP's.
• Performance Monitoring: Monitor medical network performance metrics, including cost, quality, and accessibility/segmentation, and implement improvement initiatives as needed.
• Team Collaboration: Work collaboratively with the MPM team providing support, coaching, assistance, and guidance to achieve organizational objectives.
• Collaboration: Work closely with other departments such as Claims, Business Development, CRM, Operations, and Finance to support overall organizational goals.
• Reporting: Prepare and present regular reports on network performance to senior leadership internal.
• Uses judgment, diplomacy, and confidentiality with respect to the complete procurement process, ensuring integrity.
• Withholds the reputation of the company, beneficiaries, Payers, and all other parties involved.
• Responsible to follow the Local & Regional DOAP (Delegation of Authority Policy).
• Medical Provider Training Material: Plan medical provider training per requirement and maintain updated training material in alignment with local market practices.

Minimum Requirements:

• Education: Bachelor's degree in healthcare administration, business administration, or a related field. Master's degree preferred.
• Experience: Minimum of 5-7 years of experience in healthcare network management.
• Advanced in communication and public speaking skills.
• Skills: Strong negotiation and contract management skills.
• Excellent communication and interpersonal skills.
• Analytical and problem-solving abilities.
• Knowledge of healthcare regulations and accreditation standards.
• Proficiency in relevant software and technology tools.
• Regional medical industry knowledge.

About the Company

With over 159,000 employees from 172 nationalities across more than 70 countries, we are one of the world's most trusted insurance and asset management companies. We offer a broad range of products and services in property/casualty insurance, life/health insurance, and asset management. We have our largest operational presence in Europe, and our parent company, Allianz SE, is headquartered in Munich, Germany. From jobs in Actuarial, Business and IT to Inhouse Consulting and Investment Management - your opportunities are endless!