Consultant - Program Management [Govt Health Insurance Schemes]
State Nodal Agency, Raipur, Chhattisgarh
(a) Operations and Program management: - Implementation of Ayushman Bharat-PMJAY program in the state of Chhattisgarh. (b) Capacity building, training, and coordination: Capacity building of hospitals and other stakeholders, imparting training to the Arogya Mitra (PMAM), MEDCO, in-house staff and other stakeholders. Coordination with Govt. counterparts and PMU of north-east states namely- Assam, Arunachal & Meghalaya with respect to national portability cases and other programmatic… Show more (a) Operations and Program management: - Implementation of Ayushman Bharat-PMJAY program in the state of Chhattisgarh. (b) Capacity building, training, and coordination: Capacity building of hospitals and other stakeholders, imparting training to the Arogya Mitra (PMAM), MEDCO, in-house staff and other stakeholders. Coordination with Govt. counterparts and PMU of north-east states namely- Assam, Arunachal & Meghalaya with respect to national portability cases and other programmatic activities.(c) Hospital Empanelment: -Supporting the state empanelment committee (SEC) and the district empanelment committees in internal verification and process flow for hospital empanelment under PM-JAY. Mapping of healthcare providers in the state and selection of hospitals as per AB-PMJAY guidelines.(d) Beneficiary Identification System (BIS): -Preparation of beneficiary data, data verification, and related tasks required for enrolment of beneficiaries.(e) Training & Supportive supervision: -Conduct and facilitate training for stakeholder at state & district level. Organization of trainings for district officials, hospital personnel and other stakeholders of AB-PMJAY.(f) Medical Audit & Fraud control activities: -To conduct a desk review of cases under medical audit, BIS and hospital audit, audit of suspicious and death cases, etc. Field visits to monitor the implementation of AB-PMJAY. Review of fraud-triggered cases flagged by NAFU.(g) Anti-Fraud efforts: -Fraud detection, classification, monitoring and reporting at State level. Support in fraud prevention and detection activities including fraud audits at the State level.(h) Data Management: -Analysis of data on enrolments, hospitalizations, and claims settlement. Collaboration with stake holders, partners, and line departments. MIS reporting and preparation.(i) Advocacy & Coordination: - Coordination and follow-up with district and block-level officials for implementation of AB-PMJAY. Show less