Manager Facility Inspections

23 Jul 2026 Manager Facility Inspections at NHIMA

• Provide technical oversight to clinical/claims audits of accredited healthcare facilities, and reporting. • Ensure accredited HCPs comply with Clinical Guidelines/Protocols and Standards. • Monitor and Evaluate adherence to NHIMA Claim Guidelines and Protocols, • Facilitate and provide technical input stakeholder engagement activities aimed at enhancing quality of insured health services provided, • Recommend for post audit relevant suctions to health care providers. • Communicate findings and recommendations of clinical/claims audits to Director Quality Assurance and Accreditation, Management Accreditation committee, QAA committee of the board, Ministry of Health, accredited facility and other relevant bodies. • Facilitate clawback of fraudulent and erroneously claimed reimbursements, • Development of Clinical Inspections Unit Annual Work Plan, • Provide technical oversight to the quarterly monitoring and evaluation of Annual Work Plan implementation • Provide input to the QAA Departmental Annual Work Plan • Represent the Unit in departmental trainings and continuous professional development to build dynamic capacity to conduct clinical audits and fraud investigations to assigned HCPs in line with the Authority policies. • Design and implement customised data collection tools for clinical audit and fraud investigations using relevant background information and criteria, • Monitor and Evaluate claim data to identify potential clinical/claims audits, • Maintain clinical/claims audit database and audit reports, • Identify and implement relevant internal control procedures to safeguard the Authority Fund,