Senior Executive Manager ? PR Contract and Network Management

Job Description

The Senior Executive Manager ? PR Contract and Network Management will 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 develop new products & services that support business development & proposition in the insurance market and achieve business profitability and expansion goals.Contract Management

• Set up the contracts? rules and standards with all providers for the best interest of the business
• 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 comprehensive 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, formularies 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 centres 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 stakeholders.
• Communicate regular price forecast to the commercial finance
• Communicate network 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, necessary tools and support required to achieve the organizational development objectives
• Build the capabilities of the team members.

Keyskills :