Senior Manager, Medical Network Management

  • Competitive
  • Hong Kong
  • Permanent, Full time
  • Manulife Hong Kong
  • 21 Oct 18

Senior Manager, Medical Network Management

Are you looking for unlimited opportunities to develop and succeed? With work that challenges and makes a difference, within a flexible and supportive environment, we can help our customers achieve their dreams and aspirations.

Job Description
Responsible for establishing the strategy, creation, direction and evolution of the provider network. The incumbent shall (1) liaise with providers and conduct ongoing evaluation of network performance so as to ensure a complete, stable, accessible well-regarded and high quality delivery system; and (2) to review the overall workflow of the Medical Services functions.

Responsibilities

Lead & execute the functions of Network Management services

1. Setup and maintain provider network:

  • Initiate and maintain network provider for medical services.
  • Administer credentialing process and operation of network provider.
  • Establish working procedure and identify control process for compliance to ensure service standards.
  • Accomplish the requirement for panel network to perform eligibility check and EDI claims submission for accuracy and efficiency.
  • Conduct facility visits for ensuring accuracy in panel system setup, administration and service quality at clinic
  • Monitor network adequacy and expand the network as appropriate.

2. Review network provider quality:
  • Review daily call log on network provider for both group and individual clients to identify areas for improvement.
  • Provide recommendations to network providers after investigation of reported servicing issue (for both group and individual products arrangement).
  • Monitor network providers' performance within the established service standard.
  • Conduct regular meeting with Panel Network for utilization review and service excellence and plan for service improvement
  • Plan and monitor timeline for fee schedule discussion and negotiation.
  • Identify problems which affect the Network and proactively communicate with management for improvement plan

3. Contribute to network proposal for service arrangement / product development:
  • Identify network provider combination in accordance with customer needs.
  • Coordinate and negotiate with network provider to submit proposal.
  • Prepare standard workflow, requirement and administrative guideline for implementation.
  • Recommend and execute methodology for eligibility check.
  • Conduct pre and post service review for improvement.

4. Review workflow and system capabilities for efficient delivery of health services to clients and system interface with business partners:
  • Review system performance and identify areas for technical support team to monitor for stability.
  • Review system for enhancement for efficiency and convenience for clients
  • Review overall current workflow and streamline as necessary

5. Pre-approval & Hotline Operations

Process pre-approval requests in accordance with the terms and conditions of the policy and the authority level with the turnaround time
  • Check eligibility of the member for benefit entitlement
  • Issues Letter of Guarantee whenever required
  • Approves Pre-approval with agreed fee and negotiates with the service providers to follow the logic of agreed fee
  • Provide case management and approve pre-approval
  • Resolve both operation and servicing issues encountered
  • Handle Non-Network pre-approval duties whenever required
  • Coordinate and provide training to staff

6. Other duties and responsibilities:
  • Check and look for appropriate providers for the provision of health care services for enhancing customer satisfaction.
  • Plan and design tailor made health check and other wellness programs
  • Plan and design value added services for clients as required
  • Responsible for leading the Provider Management strategy and other project initiatives relating to service or system enhancement
  • Other duties and responsibilities as assigned by supervisor.

Job Requirements
  • University Degree in Business Studies, Health Administration or relevant disciplines.
  • Minimum 8-10 years relevant experience with at least 5 years in private healthcare industry and Group insurance benefits.
  • Solid experience in medical network management.
  • Customer service and presentation experience required.
  • Strong business communication, analytical, planning, problem solving, documentation, negotiation and organizational skills.


If you are ready to unleash your potential it's time to start your career with Manulife/John Hancock.

About Manulife
Manulife Financial Corporation is a leading international financial services group that helps people achieve their dreams and aspirations by putting customers' needs first and providing the right advice and solutions. We operate as John Hancock in the United States and Manulife elsewhere. We provide financial advice, insurance, as well as wealth and asset management solutions for individuals, groups and institutions. At the end of 2016, we had approximately 35,000 employees, 70,000 agents, and thousands of distribution partners, serving more than 22 million customers. At the end of 2016, we had $977 billion (US$728 billion) in assets under management and administration, and in the previous 12 months we made almost $26 billion in payments to our customers.

Our principal operations are in Asia, Canada and the United States where we have served customers for more than 100 years. With our global headquarters in Toronto, Canada, we trade as 'MFC' on the Toronto, New York, and the Philippine stock exchanges and under '945' in Hong Kong.

Manulife is committed to supporting a culture of diversity and accessibility across the organization. It is our priority to remove barriers to provide equal access to employment. A Human Resources representative will consult with applicants contacted to participate at any stage of the recruitment process who request an accommodation. Information received regarding the accommodation needs of applicants will be addressed confidentially.