Case Management Associate
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If this job matches your qualifications, please send your application directly through our latest Job site. Indeed, every job is not easy to apply because it must meet several qualifications and requirements that we must meet in accordance with the standard criteria of the Company who are looking for potential candidates to work. Good job information Case Management Associate - Reliance Health below matches your qualifications.
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Case Management Associate Reliance Health Rest of Nigeria (Nationwide) Confidential - Minimum Qualification :
Job Description/Requirements
- Minimum Qualification :
Job Description/Requirements
The Case Management Associate is responsible for analyzing and reporting fraud, waste, and abuse data, managing the escalation of emergency cases, conducting mortality investigations, overseeing general case management and care coordination activities, managing at-risk cases, and monitoring ICU admissions of enrollees receiving healthcare services from providers within the Reliance HMO Providers network. Responsibilities
- Analyze claims data, billing records, and other relevant information to identify patterns, anomalies, and potential cases of fraud, waste, and abuse
- Utilize data analytics tools and techniques to identify trends, outliers, and potentially fraudulent activities
- Manage the escalation of emergency cases, ensuring timely and appropriate interventions for enrollees in critical or life-threatening situations
- Collaborate with healthcare providers, emergency services, and internal teams to coordinate and facilitate emergency care and support
- Conduct investigations into cases involving the mortality of enrollees to determine the cause, identify potential gaps in care, and assess the quality of care provided
- Collaborate with medical professionals, forensic experts, and internal teams to gather relevant information and conduct thorough investigations
- Monitor ICU admissions of enrollees, ensuring appropriate utilization and timely interventions, assessing the necessity and appropriateness of continued stay in the ICU
- Maintain accurate documentation of emergency cases, including communication, actions taken, and outcome
- Ensure compliance with applicable laws, regulations, and company policies related to fraud, waste, and abuse investigations, emergency Case management, mortality investigations, general case management, managing at-risk cases, and ICU admissions
Requirements
- Bachelors degree in medicine, nursing, or related disciplines
- Knowledge of healthcare operations, fraud prevention, and regulatory compliance
- Experience in conducting fraud, waste, and abuse investigations is preferred
- Knowledge of emergency management protocols and procedures
- Familiarity with mortality review processes and quality improvement initiatives
- Knowledge of legal and regulatory requirements related to fraud, waste, and abuse investigations, emergency care, and case management Professional certifications in fraud examination, case management, or related fields (e.g., Certified Fraud Examiner, Certified Case Manager) are advantageous
Benefits
- Work alongside & learn from best-in-class talent
- Private health Insurance
- Join a market leader within the health Insurance space
- Fantastic work culture Great work-life balance
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Information :
- Company : Reliance Health
- Position : Case Management Associate
- Location : Nigeria
- Country : NG
How to Submit an Application:
After reading and knowing the criteria and minimum requirements for qualifications that have been explained from the Case Management Associate job info - Reliance Health Nigeria above, thus jobseekers who feel they have not met the requirements including education, age, etc. and really feel interested in the latest job vacancies Case Management Associate job info - Reliance Health Nigeria in 2025-01-31 above, should as soon as possible complete and compile a job application file such as a job application letter, CV or curriculum vitae, FC diploma and transcripts and other supplements as described above, in order to register and take part in the admission selection for new employees in the company referred to, sent via the Next Page link below.
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Post Date : 2025-01-31
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