The Role
The Case Manager will conduct clinical case reviews at specified healthcare facilities, prioritizing the detection of fraud, waste, and abuse, as well as executing morbidity and mortality audits. This position ensures alignment between care delivery and clinical standards, ethical principles, and cost-efficiency targets. The Case Manager delivers independent, evidence-based clinical perspectives to inform decisions without commercial influence.
What You’ll Do
Perform on-site clinical evaluations at designated healthcare facilities.
Conduct a thorough evaluation of patient cases to determine the clinical appropriateness of care, assess the overall quality of services provided, and verify compliance with established healthcare standards.
Conduct morbidity and mortality audits to assess patient outcomes and uncover areas where enhancements can be made.
Deliver well-organized, data-driven guidance grounded in thorough clinical evaluations and systematic audits.
Analyze instances of unnecessary, excessive, inappropriate, or potentially fraudulent healthcare services to uncover patterns and trends.
Investigate potential instances of fraud, waste, and abuse within healthcare facilities, meticulously documenting all findings in accordance with established procedures.
Critical issues and high-risk findings must be promptly communicated to the appropriate internal stakeholders for swift resolution and risk mitigation.
Deliver objective clinical assessments and actionable recommendations grounded in thorough case reviews and supporting evidence.
Conduct thorough documentation and compile comprehensive reports after on-site facility assessments and case evaluations.
Provide actionable insights and recommendations to internal teams regarding intricate clinical cases and healthcare delivery challenges.
Establish and maintain professional interactions with healthcare providers and facility representatives throughout the review and investigation processes.
Uphold professional autonomy, impartiality, and discretion in the execution of all delegated responsibilities.
Partner with cross-functional clinical, operational, and quality teams to advance organizational objectives and enhance patient care outcomes.
Ensure adherence to relevant clinical guidelines, medical ethics standards, regulatory mandates, and internal organizational policies.
Remain up-to-date with the latest clinical guidelines, healthcare policies, and industry-leading methodologies pertinent to case management operations.
Seeking a highly organized and detail-oriented individual to manage and maintain accurate financial records. The ideal candidate must possess a Bachelor’s degree in Accounting, Finance, or a related field, along with proven experience in financial reporting and reconciliation. Proficiency in Excel and accounting software is essential, while familiarity with ERP systems is preferred. Strong analytical skills, exceptional communication abilities, and the capacity to work efficiently under tight deadlines are critical. The role involves collaborating with cross-functional teams, ensuring compliance with regulatory standards, and delivering precise financial analysis to support strategic decision-making.
What You’ll Bring
A Bachelor of Medicine, Bachelor of Surgery (MBBS or equivalent qualification) or a Bachelor of Nursing (BNS) is required for this position.
A valid and unrestricted medical or nursing license, compliant with Nigerian regulatory standards, is required for this position.
A minimum of three years of hands-on experience in a clinical setting is required.
Proficient in applying clinical guidelines and standards of care with a high degree of accuracy and consistency.
Proficiency in conducting clinical audits, performing case reviews, or engaging in hospital-based practice is required.
Maintains the highest standards of ethical conduct and professional integrity in all interactions and practices.
Possesses robust analytical capabilities and a proven ability to deliver comprehensive reports.
Proficient in executing tasks autonomously within off-site or outdoor operational settings.
Ensure adherence to all relevant regulatory standards and internal policies throughout operational processes. Implement and maintain compliance programs to mitigate risks and uphold legal and ethical obligations. Conduct regular audits and assessments to verify compliance with applicable laws, regulations, and industry best practices. Stay informed about evolving regulatory changes and proactively adjust policies and procedures to ensure ongoing compliance. Collaborate with cross-functional teams to communicate compliance requirements and provide guidance on regulatory matters.
Maintains an impeccable professional record free from any felony convictions or misconduct involving patient care, controlled substances, or breaches of professional trust.
Any ongoing or pending investigations that could impact license or professional practice must be disclosed.
Nice to Have
Proven track record in health insurance operations, including expertise in claims review and utilization management, is essential for this role.
Professional rewriting:
Candidates should possess prior experience in conducting fraud, waste, and abuse investigations.
To initiate the application process, kindly follow the established submission method. Ensure all required documentation is prepared and submitted in accordance with the specified guidelines. It is essential to adhere to the outlined timeline and requirements to guarantee the completeness and accuracy of your application.
To submit your application, kindly utilize the provided link(s) to access the company’s official website.
Qualifications
BA/BSc/HND
Experience Required
3 years
