The National Health Insurance invites qualified and professional applicants to apply for the post of Manager Health Services and Referrals.
The Health Services & Referrals Manager oversees the coordination and management of patient referral services within a health system. The role ensures timely, accurate, and efficient processing of referrals while maintaining high standards of patient care, compliance, and service delivery. The manager leads a team, optimizes workflows, collaborates with clinical and administrative stakeholders, and monitors performance to improve access, patient experience, and operational efficiency.
Essential Functions
- Provides clinical leadership and oversees the referral management process from private and public providers.
- Manages the pre-authorization process for overseas medical referrals in consultation with the NHI Medical Director, referring physicians, and overseas specialists.
- Overseas the Provider Network serving as the operational point of contact for healthcare providers regarding referrals procedures, authorizations requirements, and service delivery issues.
- Supervises and supports the clinical team, ensuring effective performance and adherence to standards.
- Provide role-specific training and professional development for staff.
- Develops, implements, and maintains efficient departmental workflows.
- Ensures approved benefits, including preauthorization rules, are correctly interpreted, documented and programmed into the claims system.
- Promotes the effective use of clinical decision-support software within medical management processes.
- Prepares and presents data to NHI Staff, the Board, network providers and the public.
- Develops and collaborates with the Medical Director to develop and update medical management policies and procedures.
- Works closely with other NHI team members and participates in committees as required.
- Ensures compliance with all applicable policies and regulatory requirements related to healthcare service delivery and beneficiary entitlements.
- Monitors emerging healthcare trends and practices to support timely updates and implementation of improvements.
- Performs additional duties as assigned.
Requirements of the position:
A) Education
Required Education: Master’s Degree
PLUS
| Field of study: Nursing, Healthcare related field (MSN, MHA, MBA) |
Work Experience: Ten (10) work experience with five (5) years management experience/Managed care/utilization/Case Management
Certificatons/Licenses Required: RNLicense (VI)
Knowledge/Skills/Abilities
- Strong clinical background, understanding of referral pathways and the practical realities of coordination of healthcare.
- Knowledge of healthcare regulations, privacy laws, and compliance requirements.
- Strong case management and problem-solving skills, with the ability to manage sensitive, high-cost, or urgent cases under pressure.
- Strong analytical skills to interpret referral and utilize data and translate it into management reports and process improvement.
- Strong written and verbal communication skills, including the ability to brief senior management and government officials.
- Proficient at identifying and resolving compliance challenges proactively.
- Ensuring meticulous adherence to policies and standards.
- Ability to manage a clinical team effectively and foster a team-based culture.
- Knowledge in Excel, Word, Outlook, and PowerPoint programs.
- Preferred experience with medical policy/procedure development.
- Comfortable in a fast-paced environment; high energy, self-motivated and is proactive.
- Ability to multitask and be flexible regarding workload and assignments.
- Ability to exercise judgement.
- Commitment to excellence demonstrated by the delivery of quality and timely outcomes.
- Sound critical thinking and organizational skills.
- Excellent time management skills.
Application Reference # – NHI-EXT-2026-03
Please send Resume/CV, cover letter and (two) 2 professional references to the:
Human Resources Manager
Social Security Board
P.O. Box 698
Road Town, Tortola
Virgin Islands
VG1110
[email protected]
Closing Date: July 29th, 2026
