Head Provider Network Management

PROTECTHEALTH CORPORATION SDN. BHD.; Cyberjaya; On-site; MYR 240,000 - 360,000; Full time

Job summary

ProtectHealth Corporation Sdn Bhd in Malaysia seeks Head of Provider Network Management to lead the strategic development, governance and performance of its MediAsas provider network.

You will oversee empanelment, onboarding, performance management and contract administration, drive cost containment, improve care outcomes and manage Fraud, Waste & Abuse initiatives while negotiating with providers and collaborating with internal teams.

Qualifications

• Bachelor’s degree in a healthcare or related field.
• Experience in provider network management or healthcare administration.
• Experience in cost containment and FWA (Fraud, Waste & Abuse).
• Strong negotiation and stakeholder management.

Responsibilities

• Lead strategy, development and optimisation of the healthcare provider network.
• Oversee the provider lifecycle: empanelment, credentialing, onboarding, renewal, suspension and termination.
• Drive provider performance via KPIs, SLAs and continuous improvement.
• Build and maintain relationships with providers, vendors and stakeholders.
• Lead commercial negotiations and support cost-containment initiatives.
• Collaborate with Analytics to monitor utilisation, performance, costs and outcomes.
• Support FWA identification and management.
• Ensure compliance with contracts and regulatory requirements.
• Drive process improvement and digitalisation within provider network management.
• Lead and develop the Provider Network Management team.

Skills

Commercial negotiation

Contract management

Stakeholder management

Leadership

Education

Bachelor’s Degree in Healthcare Management

Bachelor’s Degree in Medicine

Bachelor’s Degree in Pharmacy

Bachelor’s Degree in Nursing

Bachelor’s Degree in Allied Health

Bachelor’s Degree in Business Administration

Job description

About the role

The Head, Provider Network Management will lead the strategic development, governance and performance of ProtectHealth’s healthcare provider network for the MediAsas programme. The role oversees the end-to-end provider lifecycle, including empanelment, onboarding, performance management, contract administration and provider relationships, while driving cost containment, care outcomes and Fraud, Waste & Abuse (FWA) initiatives. The incumbent will also lead commercial negotiations, strengthen provider performance and compliance, and work closely with internal and external stakeholders to ensure a high-quality, efficient and sustainable provider network.

Key responsibilities

Lead the strategy, development and optimisation of the healthcare provider network.

Oversee the end-to-end provider lifecycle, including empanelment, credentialing, onboarding, renewal, suspension and termination.

Drive provider performance through KPIs, SLAs and continuous improvement initiatives.

Build and maintain strong relationships with healthcare providers, vendors and strategic stakeholders.

Lead commercial negotiations and support healthcare cost-containment initiatives.

Collaborate with the Analytics team to monitor utilisation, provider performance, costs and care outcomes.

Support the identification and management of Fraud, Waste & Abuse (FWA).

Ensure provider operations comply with organisational, contractual and regulatory requirements.

Drive process improvement and digitalisation within provider network management.

Lead, coach and develop the Provider Network Management team.

What we're looking for

Bachelor’s Degree in Healthcare Management, Medicine, Pharmacy, Nursing, Allied Health, Business Administration, Health Administration or a related discipline.

Approximately 10 years of relevant healthcare industry experience, preferably within hospitals, health insurance, managed care, TPA or provider network management.

Strong hands-on experience in provider/panel network management.

Experience in FWA and/or healthcare cost containment.

Strong commercial negotiation, contract and stakeholder management capabilities.

Demonstrated leadership and people-management experience.

Experience in patient/care outcome management or analysis would be an added advantage.

You’ll be a strong fit if you are:

Strategic yet operationally hands-on, commercially astute, data-driven, comfortable managing complex healthcare stakeholders, and passionate about building a high-performing and sustainable healthcare provider network.

Unlock job insights

Hirer responsiveness Salary match Number of applicants

Your application will include the following questions:

• Which of the following statements best describes your right to work in Malaysia?
• What's your expected monthly basic salary?
• Which of the following types of qualifications do you have?
• Do you have management experience in the healthcare services industry?
• How many years of experience do you have in the Health Insurance Industry?
• How many years of Commercial Negotiation experience do you have?

Incorporated on 19 December 2016, ProtectHealth Corporation Sdn Bhd (ProtectHealth) is a wholly-owned subsidiary of ProtectHealth Malaysia, established under the Ministry of Health, Malaysia (MOH).

As a not-for-profit company, ProtectHealth coordinates, administers and manages initiatives related to financing healthcare services as mandated by MOH.

Incorporated on 19 December 2016, ProtectHealth Corporation Sdn Bhd (ProtectHealth) is a wholly-owned subsidiary of ProtectHealth Malaysia, established under the Ministry of Health, Malaysia (MOH).

As a not-for-profit company, ProtectHealth coordinates, administers and manages initiatives related to financing healthcare services as mandated by MOH.

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