We are seeking a highly motivated professional to join our team in the capacity of [Job Title]. This position is responsible for overseeing key operational tasks, ensuring adherence to company standards, and driving efficiency across departmental workflows. The ideal candidate will possess a minimum of [X] years of relevant experience in [specific field or industry], along with proficiency in [specific software, tools, or methodologies]. Strong analytical skills, exceptional problem-solving abilities, and the capacity to collaborate effectively within cross-functional teams are essential. Additionally, the role requires a keen attention to detail, outstanding communication skills, and the ability to manage multiple priorities in a fast-paced environment. Responsibilities include [list key responsibilities, e.g., project coordination, data analysis, stakeholder management, etc.], with a focus on delivering measurable results and contributing to long-term organizational growth.
The Case Manager will conduct thorough clinical case reviews at assigned healthcare facilities, concentrating on the detection of fraud, waste, and abuse, as well as performing morbidity and mortality audits. This position ensures adherence to clinical standards, ethical guidelines, and cost-efficiency benchmarks in care delivery. The Case Manager delivers objective, evidence-based clinical insights to inform decision-making, free from any commercial influence.
What You’ll Do
Perform on-site clinical evaluations at designated healthcare facilities to ensure compliance with established standards.
Conduct thorough evaluations of patient cases to determine the clinical suitability, quality of healthcare delivery, and compliance with established protocols and guidelines.
Conduct morbidity and mortality audits to assess patient outcomes and pinpoint areas where improvements can be made.
Deliver comprehensive, evidence-backed recommendations derived from thorough clinical assessments and systematic audits.
Analyze and detect instances of unwarranted, disproportionate, or improper healthcare services, including potential fraudulent activities.
Investigates potential instances of fraud, waste, and abuse within healthcare facilities, meticulously documenting findings to ensure thorough and accurate reporting.
Critical issues and high-risk findings must be promptly communicated to the relevant internal stakeholders for swift resolution and mitigation.
Deliver objective clinical evaluations and informed recommendations by analyzing reviewed cases and synthesizing available evidence.
Compile comprehensive reports and documentation after conducting facility visits and reviewing cases.
Offer strategic guidance and actionable insights to internal teams regarding intricate clinical cases and healthcare delivery challenges.
Professionally interact with healthcare providers and facility representatives throughout the review and investigation processes.
Uphold professional autonomy, impartiality, and discretion in the execution of all assigned responsibilities.
Partner with internal clinical, operational, and quality teams to advance organizational objectives and enhance healthcare delivery.
To guarantee adherence to relevant clinical guidelines, uphold medical ethics, meet regulatory standards, and align with organizational policies.
To remain abreast of evolving clinical standards, healthcare regulations, and industry-leading best practices pertinent to case management functions, you will continuously monitor developments in the field.
Requirements
What You’ll Bring
A Bachelor of Medicine, Bachelor of Surgery (MBBS or an equivalent qualification) or a Bachelor of Nursing Science (BNS) is required.
A valid, unrestricted medical or nursing license for practice within Nigeria is required.
Clinical practice experience of at least three years is required.
Possesses a comprehensive grasp of clinical guidelines and established standards of care.
Proven expertise in conducting clinical audits, performing comprehensive case reviews, or working within hospital practice settings is essential.
Maintains an unwavering commitment to ethical standards and professional integrity in all medical practices.
Strong analytical and reporting skills
Capacity to operate autonomously within field-based settings without direct supervision.
Ensure adherence to all applicable regulatory, legal, and industry standards governing business operations, including but not limited to data protection laws, anti-money laundering regulations, and financial reporting requirements. Develop, implement, and maintain robust policies and procedures to mitigate compliance risks and foster a culture of ethical conduct across the organization. Conduct regular audits, risk assessments, and training programs to reinforce compliance awareness and ensure continuous improvement in regulatory adherence. Collaborate with senior management and external stakeholders to address compliance gaps and align business practices with evolving regulatory expectations.
No history of felony or misconduct related to patient care, controlled substances, or professional trust
Ongoing or pending investigations that could impact license or professional practice must be disclosed.
Nice to Have
Proficient in health insurance operations, claims adjudication, or utilization management is required.
Individuals should possess prior experience in conducting investigations related to fraud, waste, and abuse to ensure a thorough understanding of investigative processes and compliance requirements.
go to method of application
To submit your application, please utilize the provided link(s) on the company’s official website.
Qualifications
BA/BSc/HND
Experience Required
3 years
