Reliance Health uses Technology to Make Healthcare Accessible and Affordable. Through an integrated approach that includes affordable health insurance, telemedicine, and a combination of partner and proprietary healthcare facilities, Reliance Health offers innovative healthcare solutions that meet the needs of emerging markets.
We are recruiting to fill the position below:
Job Title: Case Manager (Freelance)
Location: Kano
The Role
- The Case Manager will be responsible for conducting clinical case reviews at designated healthcare facilities, with a focus on identifying fraud, waste, and abuse, as well as performing morbidity and mortality audits.
- The role ensures that care delivery aligns with clinical standards, ethical guidelines, and cost-efficiency expectations.
- The Case Manager provides independent, evidence-based clinical insights to support decision-making without commercial bias.
What You'll Do
- Conduct on-site clinical reviews at assigned healthcare facilities.
- Review patient cases to assess clinical appropriateness, quality of care, and adherence to established standards.
- Perform morbidity and mortality audits to evaluate patient outcomes and identify opportunities for improvement.
- Provide structured, evidence-based recommendations following clinical reviews and audits.
- Identify patterns of unnecessary, excessive, inappropriate, or potentially fraudulent healthcare services.
- Investigate suspected cases of fraud, waste, and abuse at healthcare facility level and document findings accordingly.
- Escalate critical issues and high-risk findings to the appropriate internal stakeholders.
- Provide independent clinical opinions and recommendations based on reviewed cases and available evidence.
- Prepare detailed reports and documentation following facility visits and case reviews.
- Support internal teams with insights and recommendations on complex clinical cases and healthcare delivery concerns.
- Engage professionally with healthcare providers and facility representatives during reviews and investigations.
- Maintain professional independence, objectivity, and confidentiality while carrying out assigned duties.
- Collaborate with internal clinical, operations, and quality teams to support organizational goals and healthcare outcomes.
- Ensure compliance with applicable clinical guidelines, medical ethics, regulatory requirements, and organizational policies.
- Stay informed on current clinical standards, healthcare regulations, and industry best practices relevant to case management activities.
Requirements
What You'll Bring:
- Bachelor of Medicine, Bachelor of Surgery (MBBS or equivalent) or Bachelor of Nursing (BNS)
- Valid, unrestricted medical or nursing license to practice in Nigeria
- Minimum of 3 years of clinical practice experience
- Strong understanding of clinical guidelines and standards of care
- Experience in clinical audits, case review, or hospital practice
- High level of integrity and adherence to medical ethics
- Strong analytical and reporting skills
- Ability to work independently in field-based environments
Compliance Requirements:
- No history of felony or misconduct related to patient care, controlled substances, or professional trust
- Must disclose any ongoing or pending investigations affecting licensure or practice
Nice to Have:
- Experience in health insurance, claims review, or utilization management
- Prior exposure to fraud, waste, and abuse investigations.
Benefits
- ₦50,000 per resolved case (Fraud, Waste & Abuse investigations)
- ₦50,000 per resolved case (Morbidity & Mortality audits).
Application Closing Date
Not Specified.
https://www.hotnigerianjobs.com/hotjobs/908580/case-manager-freelance-at-reliance-health-kano.html