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24/07 Strategic Alliance Management Services
HR Consulting at Strategic Alliance Management Services

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Senior Consultant - Health Benefit Package - National Health Authority (3-7 yrs) Premium

Delhi Job Code: 836105

1. POSITIONS VACANT: Senior Consultants - Health Benefit Packages, SCON-HBP, National Health Authority (NHA), MoHFW, GoI (Four Vacancies)

2. ORGANIZATION BACKGROUND :

National Health Authority (NHA) is the apex body, responsible for implementing Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY), India's flagship health assurance scheme, providing health cover of Rs. 5 lakhs per family, per year, for secondary and tertiary care hospitalization, to over 10.74 crore poor and vulnerable families, or approximately 50 crore beneficiaries.

NHA is tasked with implementing PM-JAY at the national level.

State Health Agencies (SHAs) have been instituted by concerned states to implement PM-JAY at the state level. SHAs have full operational autonomy to implement PM-JAY in their state.

Key Functions of NHA :

Key functions of the NHA include the following:

(1) Formulation of operational guidelines, model documents and contracts, to ensure standardization and interoperability of PM-JAY;

(2) Effective implementation and regular monitoring of PM-JAY, across the country, including initiation of suitable action for course correction, as necessary;

(3) Coordination with various State Governments on a regular basis for implementing PM-JAY;

(4) Acting as an apex body for SHAs that have been set up to implement PM-JAY.

For more information about NHA, please visit https://pmjay.gov.in/about/nha

3. JOB DESCRIPTION/ RESPONSIBILITIES :

Reporting to General Manager, Health Benefit Packages, the Senior Consultants- Health Benefit Packages shall be responsible for developing guidelines for Health Benefit Packages (HBPs) and ensuring their adoption by the states and UTs. S/he shall also be responsible for development of Standard Treatment Guidelines (STGs) and process documentation for covered packages including capacity building of SHAs and other relevant stakeholders on utilization of STGs.

Key Responsibilities :

(1) Development of guidelines for HBPs and their adoption by the States/ UTs;

(2) Coordination of medical audits, hospital audits and support the Monitoring & Evaluation Division with fraud control measures, etc;

(3) Monitor and revision of Implant/ High End Consumables prices for both National and State specific package masters;

(4) Coordinate with external agencies such as BPPI, NPPA, DHR, ICMR, Ministry of AYUSH, NHM wing under MoHFW, etc;

(5) Draft and periodic update of policies on;

(a) Ensure proper fund utilization of PM-JAY by Public Hospitals in lines with the best practices across states;

(b) Use of high-end diagnostics and medical investigations;

(c) Develop unspecified package guidelines based on best practices across all states;

(d) Develop exclusion policy under PM-JAY;

(e) Good practices concerning linking up diagnostic facilities for hospitals;

(f) Convergence with CM/ PM relief fund;

(g) Convergence with National Health Programs;

(h) Salient features of incentive policy of all states, study them and list out best practices;

(i) Develop scheme for building and construction workers;

(j) Develop guidelines on selection and adoption of new packages;

(6) Adoption and implementation of Standard Treatment Workflows; Responsible for development of Standard Treatment Guidelines (STGs) and process documentation for covered packages;

(a) IT integration of STGs with the Transaction Management System;

(b) Conduct pilots of STGs across different parts of the country;

(c) Implementation of approved STGs across the country;

(d) Capacity building of SHAs and other relevant stakeholders on utilization of STGs;

(e) Perform data analysis and assess evaluation trends on utilization of STGs;

(f) Liaising with ICMR/ NCG and specialty committee experts for development and approval of STGs;

(7) Involvement and engagement with various Committees, Sub-committees and International Development Agencies supporting NHA;

(8) Undertaking of monitoring visits to states, as well as provision of support to state governments for issues relating to implementation of scheme;

(9) Resolution of Grievance;

(10) Any other responsibility assigned by NHA.

4. QUALIFICATION, SKILLS AND EXPERIENCE :

Qualifications:

Essential:

(1) MBBS/BDS/AYUSH from a recognized University/Institute; And

(2) MBA/ PGDHM/ Masters Degree in Hospital Administration/ Public Health/ Health Insurance from a reputed and recognized university or institution.

Experience:

Essential:

(1) Three years of experience in Hospital Administration, or Operations, or Healthcare Quality Management and Assurance.

(2) Prior experience in the health insurance domain is essential.

Skills and Competencies

(1) Knowledge of medical and surgical procedures, medical terminologies, treatments and epidemiology;

(2) Strong verbal and written communication and presentation skills;

(3) Computer literate with knowledge and experience of MS Office, Excel and PowerPoint;

(4) Proficient in drafting notes and letters in English and Hindi, with emphasis on spelling, punctuation, grammar and other language skills;

(5) Language skills in English and Hindi.

5. VACANCY DETAILS: Four vacancies

6. AGE LIMIT:

Not less than 25 years and not exceeding 40 years, as on the last date for receiving applications.

7. COMPENSATION OFFERED:

Gross remuneration budgeted for the position is Rs. 1,00,000/- per month.

8. LOCATION: New Delhi, NHA Office.

9. CONTRACT TYPE AND PERIOD:

The post-holder shall be engaged on a consultancy contract, initially for a period of 12 months, extendable thereafter, on the basis of performance and approval by NHA.

10. REFERENCE: SCON-HIBP

11. CONTACT INFORMATION:

Team SAMS
Strategic Alliance Management Services P Ltd.
1/1B, Choudhary Hetram House, Bharat Nagar
New Friends Colony, New Delhi 110 025
Phone Nos.: 011-41011564/65; 4081 990

Please Note: Only information input by candidates into their online application form, shall be considered for the purposes of confirming eligibility and assessing their candidature. The CV document uploaded by candidates shall be considered to comprise supplementary information, only. Requests by candidates to consider supplementary information provided in the CV document for the purposes of determining eligibility or awarding assessment scores shall not be entertained. Applications submitted through non-online modes, shall be deemed invalid.

Women-friendly workplace:

Maternity and Paternity Benefits

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