Case Manager (Freelance)

About Reliance Health

We're a healthcare technology company of 400+ people using technology to make healthcare affordable, accessible, and delightful in emerging markets. We operate across Nigeria, Egypt, Senegal, and Côte d'Ivoire, with 300,000 people depending on us for their healthcare. We're one of Time Magazine's World's Top Health tech Companies (2025).

We're a data-driven team that values ambitious thinking, simple communication, and working without micromanagement. We move fast, learn by doing, and our diverse team spans multiple nationalities and backgrounds.

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.

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

• ₦50,000 per resolved case (Fraud, Waste & Abuse investigations) 
• ₦50,000 per resolved case (Morbidity & Mortality audits)