Provider Network (Hospital Empanelment)
- Rightmatch Hr Services
- 3 Positions
- Bengaluru
- 4 days ago
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Job Description
- Experience of leading large hospital network management teams across the country for minimum 8-10 years in large Insurance companies or TPAs.
- A postgraduate degree, preferably an MBA in Healthcare Management or Hospital Administration or Marketing.
- A clinical degree (MBBS, BHMS, BAMS) combined with a management degree is highly valued.
- 8-10+ years of overall experience in the healthcare or insurance industry, with minimum 5 years in a senior leadership role managing provider networks.
- Proven network experience of developing and managing provider networks, with a track record of achieving empanelment and savings targets.
- Experience in a health insurance company, TPA, or a large hospital chain is preferred.
Job title: State Provider Network Management
Reporting to - Zonal Network Management
Location: Bangalore & Hyderabad
Job summary: Responsible for the development, expansion, and management of the company's hospital network in the respective zones. This role will be responsible for all aspects of network hospital relations, SLA negotiations, tariff costs optimization, and performance management to ensure the delivery of high-quality, cost-effective, and seamless healthcare services utilisation for our customers.
Roles and responsibilities:
1. Strategic network development
Cashless hospitals network creation: Create and execute a detailed strategy to tie-up with hospitals across the specified geography of India, focusing on key business locations.
Provider contracting and strategic provider purchasing: To be responsible for tariff negotiations and contract finalization for purchasing health services from the hospitals in accordance with the needs of our health plans.
Relationship management: Build and maintain strong, trust-based, long-term relationships with hospital management and decision-makers in Network hospitals to create a competitive advantage.
2. Operational oversight
Team leadership: Manage and mentor a team of network managers and executives, guiding them in provider tariff negotiations, provider purchasing, key relationships management, performance monitoring and provider audits.
Digital adoption and Process management: Create and streamline digital workflows for provider onboarding, credentialing, and contract renewals to reduce manual efforts.
Co-ordination: Collaborate closely with other departments such as claims, sales, operations, and customer support to ensure seamless integration and service delivery of health services utilisation by our customers.
3. Cost management and quality assurance
Tariff optimization: Gather and analyze market intelligence and utilization patterns to optimize tariff structures, ensuring competitive and sustainable pricing.
Cost optimisation and prevention of leakages: Implement strategies for cost containment and fraud management across the network and non-network providers.
Maintaining high quality healthcare standards: Monitor high standards of quality and patient safety within the network. This includes ensuring compliance with healthcare quality standards like NABH and designing mechanisms to monitor and reward quality of care provided by our network providers in.
4. Performance monitoring and analytics
KPI tracking: Define and monitor key performance indicators (KPIs) for the network team and network hospitals, including hospital revenue streams, bed occupancy rates, patient waiting times, claims service TATs for hospital operations team, and patient satisfaction scores.
Data analysis: Use data-led analytics to continuously monitor network provider performance, utilization patterns, and patient feedback to generate actionable insights.
Regulatory and Management Reporting: Prepare and present performance reports to senior management and key stakeholders like IRDAI.
Qualifications and skills
Educational qualifications
Experience
Employement Category:
Employement Type: Full timeIndustry: InsuranceRole Category: OthersFunctional Area: Not SpecifiedRole/Responsibilies: Provider Network (Hospital Empanelment)Contact Details:
Company: RightMatch HR ServicesLocation(s): Bengaluru
Keyskills: provider enrollment provider networks
Rightmatch Hr Services
RightMatch HR Services Pvt. Ltd. is a leader in Human Resource Solution Services. We are an Executive Search firm specializing Middle to Senior level recruitments in BFSI domain.
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