بوبا العربية تعلن عن وظيفة مدير تنفيذي أول لإدارة عقود العلاقات العامة في جدة

To 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 developing new products & services that support business development &proposition in the insurance market and achieve business profitability and expansion goals .

Contract Mangement:

·       Set up the  contracts’ rules and standards with all providers for the best interest of the busines

·       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 comperhensive 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 ,formularlies 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 centers 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 stalkeholders.

·       Communicate regular price forecast to the commercial finance

·       Communicate newtwork 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 , necessry tools and support required to achieve the organizational development objectives

·       Build the capabilities of the team members.

·       5 - 7 years

·       Bachelor in medicine and surgery

·       Medical practice

·       Hospital management (preferrable)

·       Contracting and pricing of services

·       Good knowledge on CCHI rules & regulations