Medical Officer

Medical Officer

NATIONAL HEALTH INSURANCE BOARD

SUMMARY / PURPOSE OF JOB:

This is a managerial position, which has departmental wide responsibility for activities and direction of the Operation department and NHIP Emergency Overseas Treatment Programme; Providing technical leadership to the Insurance Operations team, the Medical Officer formulates polies and procedures to enhance the impact of the department; monitors patients overseas to assess their progress and report to the CEO; verify the eligibility of each claims, ensure staff is properly supervised and trained; and customer concerns addressed; as well as ensuring appropriate cost efficient health care services with best medical practices in place.

RESPONSIBILITIES AND DUTIES:

 Manages the medical aspects of the NHIP Emergency Overseas Treatment Programme;

 Manages all aspects of the Operations department inclusive of all staff assigned to the department;

 Manages and develop the Operation Department Budget with the view of ensuring that the Department expenditure remains within or below the Budgeted ranges;

 Developing policies, procedures, standards and controls or effective management of the Operations Department

 Collection of statistics form ICL (the hospitals) and the private providers as required by management and the actuary

 Liaise with the NIB to identify number of employment injury and occupational disease cases.

 Enforces cost-reduction strategies and recommends initiatives in the management of patient’s care;

 Prepare Quarterly performance reports and trend analysis

 Recommends and monitors systems and procedures to facilitate achieving of objectives within the area of responsibility;

 Verifies and signs-off on overseas provider claims in order to ensure veracity of claims as well as conducts value for money audit;

 Advise on the adjudication of claims by Beneficiaries in special circumstances, outside the scope of usual and customary benefits, including overseas claims

 To make recommendations to the Board on policy decisions such as but not limited to; reimbursement and to recommend accreditation standards in line with the Health Practitioners Board or other authorized Agency.

 Conducts a sample survey of health care providers and facilities to derive baseline data on the availability and quality of services as well as the capacity and readiness to meet the demands of the NHIB;

 Coordinates activities and provides advice to the NHIB team charged with the specification and costing of the service benefit package and in the development of provider payment systems;

 Convenes and takes the lead in meetings and other mechanisms aimed at defining criteria for inclusion in the NHIB provider network, as well as developing norms and protocols for quality assurance utilization reviews, access to overseas care, and modifications ( inclusion and exclusion) of items in the benefit package;

 Collaborates with other members on the NHIB team in the design and implementation of activities related to accreditation of health providers;

 Collaborates with other members of the NHIB team in defining and developing contractual agreements with local and overseas providers for services within the benefit package;

 Assists in the development of detailed terms of reference and procedures for the activities of the NHIB Medical Review Committee.

 May perform other duties as assigned by the immediate supervisor or any other person authorized to give instructions or assignments

 Any other duty deemed appropriate and consistent with the position, professional qualification and skill set as directed by the Chief Executive Officer

WORKING RELATIONSHIPS:

 Internal – Chief Financial Officer, Insurance Claims Manager, Nurse Case Managers, Claims Officers, IT, Registration and Accounting Officers

 External - Members of the public, Ministry of Health and other TCIG Ministries, TCI Hospitals, International medical providers, Insurance Third Party Administrators

MINIMUM KNOWLEDGE, SKILLS AND ABILITIES REQUIRED:

 Principles, practices and techniques of medical case management

 Budgeting

 Team Leadership

 Good problem solving skills

 Strong written and oral skills including computer literacy in the main processing, spreadsheet and presentation graphics programmes.

 Human Relations

QUALIFICATIONS AND EXPERIENCE:

 Medical Doctor with at least 7 years’ experiences a full time practitioner in primary care and hospital settings with the necessary competencies to effectively respond to the challenges of the job.

 Business post graduate Degree

 Business Management Experience

 Knowledge of the NHIB Ordinance and Regulations

 Current (Good Standing) Registration with TCI Health Practitioners Board

 Experience with health insurance operations such as member of medical review panel will be an asset.

All Applications should be addressed to:

Human Resources Manager

National Health Insurance Board

Salt Mills Plaza

Providenciales

Turks and Caicos Islands

British West Indies