Senior Lead Case Management at Reliance HMO

Description

• This role is responsible for the design and execution of case management processes at Reliance Health that improve enrollee safety and reduces amount spent on claims secondary to waste, abuse and fraud.   

Responsibilities

• Data-driven analysis of enrolee feedback to understand trends.  
• Develop and execute a structured process to investigate cases associated with mortality, morbidity, fraud, waste, and abuse.   
• Develop and execute structured standards for inclusion or exclusion of medical providers on Reliance Health’s network.  
• Develop and execute policies and procedures to support enrolees and quantifiably improve outcomes for those requiring emergency or prolonged care and those experiencing critical illness.   
• Develop policies and practices to improve safety for enrolees seeking care within our provider network.  
• Develop policies and practices to improve medical quality within our provider network.  
• Own key performance indicators around provider quality feedback from stakeholders and reduction of claims paid for low-value, dangerous or negligent care.   

Requirements

• Minimum of Bachelor of Medicine and Bachelor of Surgery (MBBS) 
• Minimum 2 years medical experience caring for patients.   
• Minimum 1 year of proven experience leading and managing of team.  
• Additional training or experience in medical quality improvement and/or population health, data analysis skillsets is required.   
• Excellent analytical, problem solving, communication, data analysis and numeracy skills are a must have for this role.   
• Highly organized, detail-oriented, self-directed, and goal-driven with strong leadership and managerial skills   
• Successful record of accomplishment in a fast-paced organization   
• Ability to execute, accelerate impact and lead change.   
• A customer success, claims, case management, provider/insurance related work history is an added advantage.   
• Advanced proficiency in the use of Microsoft Office tools including Word, Outlook and Excel.   
• Ability to use data to drive decision making and problem solving.  
• Ability to develop and carry out protocol to support users in emergency and critical medical illness.   
• Strong crisis management and relationship management skills.  
• Must be physically present in Lagos.  
• Willingness to travel when required.