We are seeking a highly motivated individual to join our team in the capacity of [Job Title], where you will play a pivotal role in [key responsibility or function]. The ideal candidate will possess a [specific degree or certification], coupled with a minimum of [X years] of hands-on experience in [relevant field or industry]. Proficiency in [specific software, tools, or methodologies] is essential, along with strong analytical, problem-solving, and communication skills. Your responsibilities will include [list major duties], ensuring adherence to [industry standards or company policies] while driving [specific goals or outcomes]. Collaboration with cross-functional teams and the ability to manage multiple priorities in a fast-paced environment are also critical to success in this position.
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 protocols, and cost-effectiveness requirements. The Case Manager delivers objective, evidence-based clinical perspectives to inform decision-making, free from any commercial influence.
What You’ll Do
Perform on-site clinical evaluations at designated healthcare facilities.
Conduct a thorough evaluation of patient cases to determine clinical appropriateness, the quality of care provided, and compliance with established standards.
Conduct morbidity and mortality reviews to assess patient outcomes and uncover potential areas for enhancement in clinical care.
Deliver clear, evidence-driven recommendations after conducting clinical reviews and audits.
Analyze healthcare service patterns to detect instances of unnecessary, excessive, inappropriate, or potentially fraudulent activities, ensuring adherence to compliance standards and regulatory guidelines.
Investigate suspected instances of fraud, waste, and abuse occurring at the healthcare facility level, meticulously documenting all findings in a thorough and accurate manner.
Critical matters and high-risk discoveries must be promptly communicated to relevant internal stakeholders for immediate attention and resolution.
Offer expert, evidence-based clinical insights and recommendations after a thorough review of cases and supporting documentation.
Craft comprehensive reports and documentation after on-site facility inspections and case evaluations.
Provide expert guidance and strategic recommendations to internal teams regarding intricate clinical cases and key healthcare delivery challenges.
Professionally liaise with healthcare providers and facility representatives throughout reviews and investigations to ensure clear communication and adherence to established protocols.
Uphold unwavering professional integrity by exercising independent judgment, maintaining strict objectivity, and safeguarding confidential information throughout all assigned responsibilities.
Collaborate with internal clinical, operations, and quality teams to advance organizational objectives and enhance healthcare delivery.
Ensure adherence to relevant clinical guidelines, uphold medical ethics, comply with regulatory standards, and align with organizational policies.
To remain current with evolving clinical standards, healthcare regulations, and industry best practices pertinent to case management functions, it is essential to maintain ongoing awareness and engagement with these areas.
Candidates must hold a Bachelor’s degree in Computer Science, Engineering, or a closely related field, complemented by a minimum of three years of relevant professional experience. Proficiency in Python, Java, or C++ is essential, alongside a solid grasp of algorithms and data structures. Familiarity with cloud platforms such as AWS, Azure, or Google Cloud is preferred. Strong problem-solving abilities, excellent communication skills, and the capacity to work effectively in a team-driven environment are also required.
What You’ll Bring
Bachelor’s degree in Medicine and Surgery (MBBS or equivalent qualification) or Bachelor of Science in Nursing (BNS) required.
A current, unrestricted medical or nursing license permitting practice in Nigeria is required.
A minimum of three years of direct clinical practice is required.
Proficient in clinical guidelines and standards of care with a comprehensive grasp of best practices in patient management and treatment protocols.
Extensive background in conducting clinical audits, performing detailed case reviews, and applying practical experience in hospital settings.
Maintains an unwavering commitment to ethical standards and professional integrity throughout all professional interactions and decision-making processes.
Proven expertise in data analysis and the preparation of comprehensive reports is required.
Demonstrated proficiency in executing tasks autonomously within remote and field-based settings.
Compliance requirements encompass a range of essential guidelines and standards that must be adhered to in order to ensure organizational integrity and regulatory alignment. These mandates typically include adherence to legal, ethical, and industry-specific rules, as well as internal policies designed to mitigate risk and promote accountability. Key responsibilities involve monitoring regulatory changes, conducting audits, and implementing necessary adjustments to maintain compliance. Additionally, employees are expected to document processes, report discrepancies, and participate in ongoing training to stay informed about evolving standards.
Maintains an impeccable record free of any felony convictions or professional misconduct involving patient care, controlled substances, or breaches of professional trust.
All ongoing or pending investigations that could impact license or professional practice must be disclosed.
Nice to Have
Proficiency in health insurance operations, claims evaluation, or utilization management is required.
Individuals should possess prior experience in conducting investigations related to fraud, waste, and abuse to effectively identify and address irregularities within organizational operations.
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
