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Engagement Lead - Healthcare and Insurance Providers (Qatar)
Job Overview
Responsible for the on-time completion of activities related to engagement with stakeholders for the implementation of mandatory health insurance scheme of the client. Work in cross-functional team to ensure project delivery success.
Essential Functions
Participates in the design, development and delivery of stakeholder engagement & readiness components
Reviews and analyzes client requirements
Proposes and delivers cost effective solutions to meet these requirements.
Designs, structures and delivers client reports and presentations.
Engagement and readiness of different stakeholders for the successful implementation of the scheme
HCPs: Assess the readiness status and ensure seamless on-boarding of HCPs along with the concerned client team. This may include
the operational and technical readiness,
compliance of the providers in terms of e.g. data standards, billing, pricing, and
compliance with Standardized/National Provider Network Agreement (PNA) terms.
Engage with HCPs for allocation of a readiness score. This will include meetings, target timelines and ensuring HCP’s to be fully compliant prior to the roll-out of the MHIS and post-implementation.
Identify the provider network design, ensure meticulous selection criteria is in place and ensure accessibility to health care with no impact on quality of treatment. Identify and implement effective measures for quality assurance and HCP incentivization approach in coordination with the concerned stakeholders. Review and refine the coding nomenclature and claims management processes.
PHIs: Assess the readiness status and along with the concerned regulator team ensure seamless on-boarding of PHIs. This will include
the operational and technical readiness,
compliance of the providers in terms of e.g. data standards, billing, pricing, and
regulatory adaptability.
Engage with PHIs for allocation of a readiness score. This will include meetings, target timelines and ensuring PHI’s to be fully compliant prior to the roll-out of the MHIS and post-implementation.
Cross-Regulators: Engage with the cross-regulators to delineate functions and agree on collaboration moving forward. The engagement will include meetings, target timelines and cross regulators to be fully aware of their roles and HFID’s role prior to the roll-out of the MHIS and post-implementation. Develop Service Level Agreements (SLA) with stakeholders who will have regulatory roles in the Scheme, as needed. This may include technical, legal and administrative requirements.
Other Stakeholders
Prepare and continuously engage TPAs and HCBs to ensure they will be compliant with the regulatory requirement.
Qualifications
A least 15 years of experience in health insurance schemes development/implementation expertise at a regulatory level in general Works willingly and effectively with others in and across the team to accomplish project goals. Experienced with developing relationships with senior level managers and executives at clients in the healthcare insurance industry
Ability to manage multiple projects, juggle priorities and deliver on tight deadlines.
Operations Lead - Health Insurance implementation (Qatar)
Job Overview
Responsible for the on-time completion of activities related to Implementation and Monitoring of mandatory health insurance scheme (MHIS) at Qatar with other consultants.
Essential Functions
Participates in the design, development and delivery of Implementation and Monitoring Expert of the mandatory health insurance scheme (MHIS) at Qatar
Reviews and analyzes client requirements
Proposes and delivers cost effective solutions to meet these requirements.
Designs, structures and delivers client reports and presentations.
Major Deliverables under the above component
Strategic plan development : Develop a comprehensive five-year strategic plan aligned with the client strategic plan, and also aligned with other cross regulators’ jurisdictions. The plan should define the regulatory role of client along with other cross-regulatory bodies.
Operational Plan development:
Review the existing rollout plan and enhance it into a comprehensive operational plan to ensure successful launch and monitoring of the Scheme. This will include Pre-roll out, rollout and post-roll out operational plans for year (1), and operational plan for year (2) of the engagement. Develop and identify the Timeline, Milestones, Deliverables and Resources required to the successful implementation. Other objectives and activities required for the scheme implementation as per the client’s Rollout Plan, and any other requirements necessary for the successful launch and sustainability of the implementation of different phases of the Scheme. The day-to-day regulatory processes that are required for successful operations of the MHIS. Define Key Responsible Areas and KPI’s specific to launch and monitoring.
Implementation of the Scheme and targets achievement: Assist in Implementing the operational plan specific to the scheme kick-off as per the implementation phases.
Monitoring and Evaluation (M&E):
M&E of the Scheme: Provide technical expertise to develop and implement M&E system for the entire scheme, and a reporting mechanism on regular intervals.
ii. M&E of HFID performance: Provide technical expertise to develop and implement M&E system for the HFID, and a reporting mechanism on regular intervals in alignment with the relevant department of the MOPH.
Qualifications
A least 15 years of experience in health insurance schemes development/implementation expertise at a regulatory level in general Works willingly and effectively with others in and across the team to accomplish project goals. Ability to manage multiple projects, juggle priorities and deliver on tight deadlines.
How To Apply
To Learn More And To Apply Visit The Following Link
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