Case Manager (Freelance) - Kano at Reliance HMO

Job Overview

Location
Lagos, Kano
Job Type
Full Time
Date Posted
13 days ago

Additional Details

Job ID
152801
Job Views
32

Job Description






The Role




  • The Case Manager will be responsible for conducting clinical case reviews at designated healthcare facilities, with a focus on identifying fraud, waste, and abuse, as well as performing morbidity and mortality audits. The role ensures that care delivery aligns with clinical standards, ethical guidelines, and cost-efficiency expectations. The Case Manager provides independent, evidence-based clinical insights to support decision-making without commercial bias.



What You'll Do




  • Conduct on-site clinical reviews at assigned healthcare facilities

  • Review patient cases to assess clinical appropriateness, quality of care, and adherence to established standards

  • Perform morbidity and mortality audits to evaluate patient outcomes and identify opportunities for improvement

  • Provide structured, evidence-based recommendations following clinical reviews and audits

  • Identify patterns of unnecessary, excessive, inappropriate, or potentially fraudulent healthcare services

  • Investigate suspected cases of fraud, waste, and abuse at healthcare facility level and document findings accordingly

  • Escalate critical issues and high-risk findings to the appropriate internal stakeholders

  • Provide independent clinical opinions and recommendations based on reviewed cases and available evidence

  • Prepare detailed reports and documentation following facility visits and case reviews

  • Support internal teams with insights and recommendations on complex clinical cases and healthcare delivery concerns

  • Engage professionally with healthcare providers and facility representatives during reviews and investigations

  • Maintain professional independence, objectivity, and confidentiality while carrying out assigned duties

  • Collaborate with internal clinical, operations, and quality teams to support organizational goals and healthcare outcomes

  • Ensure compliance with applicable clinical guidelines, medical ethics, regulatory requirements, and organizational policies

  • Stay informed on current clinical standards, healthcare regulations, and industry best practices relevant to case management activities



Requirements

What You'll Bring




  • Bachelor of Medicine, Bachelor of Surgery (MBBS or equivalent) or Bachelor of Nursing (BNS)

  • Valid, unrestricted medical or nursing license to practice in Nigeria

  • Minimum of 3 years of clinical practice experience

  • Strong understanding of clinical guidelines and standards of care

  • Experience in clinical audits, case review, or hospital practice

  • High level of integrity and adherence to medical ethics

  • Strong analytical and reporting skills

  • Ability to work independently in field-based environments



Compliance Requirements:




  • No history of felony or misconduct related to patient care, controlled substances, or professional trust

  • Must disclose any ongoing or pending investigations affecting licensure or practice



Nice to Have




  • Experience in health insurance, claims review, or utilization management

  • Prior exposure to fraud, waste, and abuse investigations



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