Job Description
Sterling Health HMO is a National Health Insurance Agency (NHIA)-accredited Health Maintenance Organization (HMO) that has been providing 24/7/365 quality affordable healthcare service to the public and private sector nationally since 2007.
Job Description
- Conduct medical assessments of enrollees as required for specific programs or cases.
- Provide expert medical opinions and recommendations.
- Participate in case reviews and multidisciplinary team meetings.
Utilization Review and Management:
- Evaluate the medical necessity and appropriateness of healthcare services requested by enrollees or provided by healthcare providers.
- Apply clinical guidelines and protocols to ensure cost-effective and quality care.
- Communicate with healthcare providers to clarify treatment plans and ensure adherence to guidelines.
- Authorize or pre-authorize medical services according to Sterling Health Insurance policies.
- Assist in the evaluation and credentialing of healthcare providers within our network.
- Serve as a medical liaison between Sterling Health Insurance and healthcare providers.
- Participate in provider meetings and address medical-related inquiries.
- Contribute to the development and review of medical policies, procedures, and clinical guidelines.
- Ensure that policies are evidence-based and aligned with best practices.
- Review complex or high-cost claims to ensure medical necessity and appropriate billing.
- Provide medical expertise to the claims processing team.
- Provide medical training and education to non-medical staff on relevant healthcare topics.
- Develop educational materials for enrollees on health-related issues.
Application Closing Date
1st May, 2025.
Method of Application
Interested and qualified candidates should forward their CV to: Sterlinghmo@gmail.com using the job title as the subject of the email.
Share job
Job Overview
-
Company
WorkflowsHR
-
Experience
2+ Years
-
Location
Lagos
-
Offered Salary
Confidential
-
Qualification
Degree
-
Industry
Medical, Healthcare
-
Date Posted
April 29, 2025