Zonal Provider Management - Hospital Networking

The role is with a General Insurance firm.

Job title: Lead Zonal Hospital Network Management

Reporting to Head of Claims and Network Management

Location: Bangalore (South Zone)

Geographical extent of the Zones: South Zone

Job summary: This senior leadership role is 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:

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.

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.

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.

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.

Market intelligence and compliance

• Market intelligence: Stay updated on market dynamics, emerging trends in healthcare, regulatory changes (including those from IRDAI and government health schemes like ABDM), and competitive benchmarks to inform strategic decisions.
• Digital first Advocacy: Champion digital health frameworks like creating our own hospital relationship management platform and platforms used by the Ayushman Bharat
• Digital Mission (ABDM) and National Health Claims Exchange (NHCX) to foster interoperability and detailed integration of our claims platform with NHCX and related stakeholders / aggregators.

Experience

• 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.