Case Manager (Freelance)

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. 

How to Apply
Interested and qualified candidates should:
Click here to apply online

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