Freelance Case Management (Ikot Epkene)

The Freelance Case Management Associate at Reliance Health is tasked with analyzing claims data and reporting on fraud, waste, and abuse within the healthcare system. Key responsibilities include managing emergency case escalations, conducting mortality investigations, and overseeing general case management activities, including monitoring ICU admissions for enrollees. This role is critical in ensuring that compliance with healthcare regulations and policies is maintained.

To qualify for the Freelance Case Management Associate position at Reliance Health, candidates should possess a Bachelor's degree in medicine, nursing, or related disciplines. Additionally, knowledge of healthcare operations and previous experience in fraud investigations are highly desirable. Professional certifications in fraud examination or case management can further enhance a candidate's profile.

Reliance Health is committed to the professional growth of its team members, including Freelance Case Management Associates. Employees have access to tools, mentorship, and resources for skill elevation, along with a dedicated learning and development allowance designed to foster ongoing professional growth and advanced skill enhancement.

At Reliance Health, the work culture is collaborative and inclusive, emphasizing team efforts and celebrating diversity. Freelance Case Management Associates can expect to work in a supportive environment where their contributions are valued, and they are encouraged to bring their unique perspectives to the table.

As a Freelance Case Management Associate at Reliance Health, you will enjoy a competitive salary complemented by premium health insurance for you and your family. Furthermore, the position offers unlimited leave for work-life balance, alongside opportunities to make a meaningful impact within the healthcare community.

When answering this question, highlight any past roles where you were responsible for analyzing healthcare data, such as claims records or billing information. Be specific about the tools you used, the types of anomalies you identified, and how your analysis contributed to detecting fraud or improving patient care.

In your response, provide a specific example detailing the scenario, your action steps, and the outcome. Highlight your ability to stay calm under pressure and the collaboration with other medical professionals to ensure the best results for the patient.

To address compliance, discuss your knowledge of relevant laws and regulations related to fraud, waste, and abuse investigations. Explain how you implement these guidelines in your case management processes to ensure adherence and safety within healthcare practices.

When discussing detection techniques, talk about various analytic tools or methods you've employed in your previous roles. Explain how you interpret data patterns and collaborate with forensic experts to investigate anomalies systematically.

In answering this question, convey your understanding of mortality review processes and quality improvement initiatives. Describe your approach to conducting thorough investigations and identifying root causes, as well as how you document findings effectively.

Illustrate your conflict resolution skills by recalling a situation where you had a disagreement with a colleague. Emphasize the importance of open communication and collaboration in finding a solution that serves both the team and the patient's best interests.

Express your understanding of current challenges, such as managing healthcare costs or ensuring quality care while protecting against fraud. Discuss innovative strategies or technologies that could help address these issues within the case management framework.

Provide a structured response outlining how you assess cases, collaborate with healthcare providers, and develop plans tailored to each patient’s needs. Mention your track record in ensuring all parties stay informed and engaged throughout the process.

In your answer, share your passion for making a real difference in patients' lives and improving healthcare systems. Discuss specific aspects of case management that excite you, such as the challenge of problem-solving or the satisfaction of fostering better patient outcomes.

When addressing this question, connect your values to the mission of Reliance Health. Talk about your commitment to transforming patient care and how the company’s innovative approach to healthcare aligns with your professional aspirations and ethical beliefs.