The Role
The Case Manager will conduct clinical case reviews at specified healthcare facilities, emphasizing the detection of fraud, waste, and abuse while performing morbidity and mortality audits. This role ensures care delivery meets clinical standards, ethical guidelines, and cost-efficiency targets. The Case Manager delivers objective, evidence-based clinical perspectives to inform decision-making, free from commercial influence.
What You’ll Do
Perform on-site clinical assessments at designated healthcare facilities.
Conduct a comprehensive evaluation of patient cases to determine clinical appropriateness, ensure the delivery of high-quality care, and verify compliance with established standards.
Conduct morbidity and mortality audits to assess patient outcomes and pinpoint areas where enhancements can be made.
Deliver well-organized, data-driven recommendations derived from thorough clinical evaluations and systematic audits.
Analyze patterns indicative of unnecessary, excessive, inappropriate, or potentially fraudulent healthcare services.
Investigate potential instances of fraud, waste, and abuse at the healthcare facility level, meticulously compiling and recording findings in accordance with established protocols.
Critical issues and high-risk findings must be promptly communicated to the relevant internal stakeholders to ensure timely resolution and risk mitigation.
Deliver impartial clinical assessments and guidance grounded in case evaluations and relevant evidence.
Compose comprehensive reports and documentation after on-site inspections and case evaluations.
Provide expert guidance and actionable insights to internal teams addressing intricate clinical cases and critical healthcare delivery challenges.
Professionally interact with healthcare providers and facility representatives throughout assessments and inquiries.
Ensure adherence to professional independence, objectivity, and confidentiality in the execution of all assigned responsibilities.
Partner with cross-functional clinical, operational, and quality assurance teams to advance organizational objectives and enhance healthcare delivery.
Ensure adherence to relevant clinical guidelines, medical ethics standards, regulatory mandates, and internal organizational policies.
Remain up-to-date on the latest clinical standards, healthcare regulations, and industry best practices pertinent to case management functions.
Seeking a candidate with a minimum of five years of experience in a related field, preferably holding a degree in a relevant discipline. Must demonstrate proficiency in project management software and possess strong analytical skills to interpret complex data sets. Familiarity with industry regulations and compliance standards is essential. Excellent communication skills, both written and verbal, are required to liaise with stakeholders and present findings effectively. The position demands a collaborative mindset, attention to detail, and the ability to meet tight deadlines in a fast-paced environment.
What You’ll Bring
We seek candidates with a Bachelor of Medicine and Bachelor of Surgery (MBBS or equivalent) or a Bachelor of Nursing Science (BNS) degree.
A valid and unrestricted medical or nursing license issued by the relevant Nigerian regulatory body is required.
A minimum of three years of hands-on clinical practice experience is required.
Demonstrates a comprehensive knowledge of clinical guidelines and established standards of care.
Proven expertise in conducting clinical audits, performing comprehensive case reviews, or hands-on experience in hospital-based practice settings is required.
Maintains the highest standards of ethical conduct and professional integrity in accordance with medical ethics guidelines.
Exceptional proficiency in data analysis and report generation is required. Candidates must demonstrate a keen ability to interpret complex information and communicate findings effectively. Proficiency in analytical tools and reporting software is highly advantageous.
Proven capability to operate autonomously in remote, field-based settings with minimal direct supervision.
Compliance requirements encompass the necessary policies, procedures, and regulatory standards that must be adhered to in order to ensure organizational adherence to legal, ethical, and industry-specific obligations. These mandates typically include adherence to data protection laws, anti-corruption regulations, financial reporting standards, and workplace safety protocols. Professionals in this role are expected to maintain up-to-date knowledge of evolving regulatory frameworks, conduct regular audits to identify potential risks, and implement corrective measures to mitigate compliance breaches. Additionally, they must facilitate training programs to promote a culture of compliance across all levels of the organization and ensure that all business activities align with applicable laws and internal policies.
Maintains a clean professional record free of any felony convictions or misconduct involving patient care, controlled substances, or violations of professional trust.
Ongoing or pending investigations that could impact license or professional practice must be disclosed.
Nice to Have
Seeking candidates with demonstrated proficiency in health insurance, claims adjudication, or utilization management, ensuring adherence to industry standards and regulatory requirements.
Individuals should possess prior experience in investigating instances of fraud, waste, and abuse to qualify for this role.
To initiate the application process, please follow the provided method of application. This structured approach ensures all necessary steps are completed accurately and efficiently. Candidates are advised to review the outlined procedures carefully before proceeding. Each stage of the application is designed to streamline the submission while maintaining clarity and professionalism. Adhering to this method will facilitate a smooth and timely review of your application.
To submit your application, please utilize the provided links on the company’s official website.
Qualifications
BA/BSc/HND
Experience Required
3 years
