We’re seeking a highly motivated professional to join our team in a dynamic and collaborative environment. This position offers an opportunity to contribute to meaningful projects while developing your skills in a supportive workplace. Key responsibilities include managing multiple priorities, ensuring accuracy in all deliverables, and maintaining strong communication with stakeholders. The ideal candidate will possess a minimum of three years of relevant experience, proficiency in industry-standard tools, and the ability to work independently as well as part of a team. A commitment to continuous learning and adaptability in a fast-paced setting are essential. This role requires a detail-oriented individual who thrives in solving complex problems and delivering high-quality results.
The Case Manager will conduct thorough clinical case reviews at assigned healthcare facilities, prioritizing the detection of fraud, waste, and abuse, as well as performing morbidity and mortality audits. This position ensures care delivery complies with clinical standards, ethical guidelines, and cost-efficiency requirements. The Case Manager delivers objective, evidence-based clinical insights to inform decision-making, free from any commercial influence.
What You’ll Do
Perform in-person clinical assessments at designated healthcare facilities.
Conduct thorough evaluations of patient cases to determine the clinical necessity, quality of care provided, and compliance with established guidelines and standards.
Conduct morbidity and mortality reviews to assess patient outcomes and pinpoint areas where improvements can be made.
Deliver well-organized, data-driven recommendations derived from thorough clinical evaluations and systematic audits.
Analyze data to detect instances of unwarranted, excessive, inappropriate, or potentially fraudulent healthcare services.
Investigate potential instances of fraud, waste, and abuse within healthcare facilities, meticulously documenting all findings to ensure thorough and accurate reporting.
Critical issues and high-risk findings must be promptly communicated to relevant internal stakeholders for immediate attention and resolution.
Deliver impartial clinical evaluations and expert guidance grounded in comprehensive case reviews and the most current evidence.
Compose comprehensive reports and documentation after conducting facility visits and case reviews.
Provide expert guidance and actionable insights to internal teams regarding intricate clinical cases and challenges in healthcare delivery.
Professional interaction with healthcare providers and facility representatives is expected, particularly during evaluations and inquiries.
Uphold professional autonomy, impartiality, and discretion when executing designated responsibilities.
Partner with internal clinical, operations, and quality teams to advance organizational objectives and enhance healthcare delivery.
To uphold adherence to relevant clinical guidelines, medical ethics, regulatory mandates, and internal organizational policies.
To remain abreast of evolving clinical standards, healthcare regulations, and industry best practices pertinent to case management functions.
Must possess at least 5 years of experience in a relevant field with a proven track record of leadership and project management. Bachelor’s degree in a related discipline is required; advanced degrees are preferred. Strong analytical, problem-solving, and communication skills are essential. Proficiency in industry-specific software and tools is mandatory. Must demonstrate the ability to work in fast-paced environments, multitask effectively, and meet tight deadlines. Excellent interpersonal skills with the capacity to collaborate across departments are critical. Familiarity with regulatory compliance and quality assurance standards is a must. Ability to mentor junior team members and foster a culture of continuous improvement is valued. Must be detail-oriented, organized, and capable of managing multiple priorities without compromising accuracy.
What You’ll Bring
Bachelor of Medicine, Bachelor of Surgery (MBBS or its equivalent) or a Bachelor of Nursing (BNS) degree is required.
Applicants must possess a current, active medical or nursing license that is unrestricted and valid for practice in Nigeria.
Requires a minimum of three years of hands-on clinical practice experience.
Demonstrates a comprehensive grasp of clinical best practices and established standards of care in the field.
Proficiency in conducting clinical audits, performing comprehensive case reviews, or working within a hospital setting is required.
Maintaining a strong commitment to ethical standards and professional integrity is essential.
Demonstrates exceptional proficiency in analyzing complex data sets and generating insightful reports to support decision-making processes.
Proven capability to operate autonomously in remote or outdoor work settings, demonstrating self-sufficiency and adaptability to varied field conditions.
Compliance obligations necessitate strict adherence to all relevant regulatory standards, industry guidelines, and internal policies to ensure organizational integrity and legal conformity. Professionals in this role must demonstrate a comprehensive understanding of applicable laws, such as anti-money laundering (AML) regulations, data protection statutes, and financial reporting requirements, while maintaining up-to-date knowledge of evolving compliance frameworks. Responsibilities include conducting regular audits, risk assessments, and training sessions to mitigate potential violations, fostering a culture of ethical behavior, and implementing corrective measures as needed to address any identified gaps or deficiencies.
A clean record with no prior felony convictions or misconduct incidents involving patient care, controlled substances, or professional integrity is required.
Any ongoing or pending investigations that may impact license or professional practice must be disclosed.
Nice to Have
Proficiency in health insurance operations, claims adjudication, or utilization management is required.
Professional experience involving fraud, waste, and abuse investigations is required.
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Applications should be submitted by following the specified method outlined in the job posting. Ensure all required documents and information are included to facilitate the review process. Follow the instructions precisely to avoid any delays in the application evaluation. The chosen submission method is designed to streamline the process for both applicants and the hiring team.
To initiate the application process, please utilize the provided link(s) to submit your application directly through the company’s official website.
Qualifications
BA/BSc/HND
Experience Required
3 years
