Care Coordinator – Medical Care Management

About the role

The Care Coordinator oversees and coordinates the medical care of HMO members, ensuring timely, appropriate, and high-quality healthcare services in line with clinical guidelines and policies.

Key responsibilities

• Review and coordinate member care, including admissions, referrals, and specialist services, while assessing medical necessity.
• Conduct utilization management and clinical reviews for authorizations, procedures, and high-cost treatments, recommending cost-effective alternatives.
• Liaise with hospitals, clinics, and specialists to facilitate service delivery and support provider relations.
• Maintain accurate medical records, prepare clinical reports, and ensure compliance with NHIA regulations and company policies.
• Uphold data protection and confidentiality standards, reporting any breaches and following security guidelines.
• Perform any additional duties assigned by the company, including supporting the Head of IT as needed.

Required profile

• Bachelor of Medicine, Bachelor of Surgery (MBBS or equivalent) and a valid practicing license with the Medical and Dental Council of Nigeria.
• Minimum 3–5 years post-qualification experience in an HMO, hospital, or managed-care environment.