Case Manager (Freelance) – Kano at Reliance HMO
We’re a health insurance company that acts like a technology company. We’re using software, data science and telemedicine to make health insurance more affordable, easier to access and more of a delightful experienceThe 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