Clinical Case Manager

About

The Role Team – Complex Care Working Pattern - Hybrid – 2 days per week in the Vitality Bournemouth or Stockport Office. Full time, 35 hours per week. We are happy to discuss flexible working! Top 3 skills needed for this role:
Clinical Case Management Clinical Decision Making Complex Care Navigation What this role is all about:
We're looking for a Clinical Case Manager to work within the Complex Care Team. This role manages complex, long-term healthcare claims, including oncology cases. Using clinical expertise and sound judgement, the Clinical Case Manager ensures members receive the benefits and treatment available under their cover while delivering proactive care navigation, effective provider management and commercially responsible claims decisions. Key Actions Manage a portfolio of complex, long-term healthcare claims, assessing and reassessing eligibility throughout each member's treatment journey Provide clear, professional and compassionate support to members, explaining the case management process and maintaining regular contact throughout the claim Analyse clinical and policy information to make accurate technical decisions within agreed authority levels and established claims positions Coordinate proactively with consultants, hospitals, clinics and other care providers to obtain the information required for timely claims decisions Navigate members towards appropriate treatment pathways, preferred providers and relevant partner services based on their individual circumstances Identify and deliver sustainable claims savings through provider management, NHS cash benefits, home care options and the prevention of ineligible costs Act as a clinical and technical point of reference for complex queries and escalations from members, representatives, colleagues and wider business teams Maintain complete and accurate records of member contact, eligibility assessments, decisions, savings, quality measures and productivity outcomes Contribute to audits, projects and the ongoing development of Complex Care processes, procedures and technical reference materials Support team capability through knowledge sharing, mentoring, coaching, quality audits and the induction and training of new Case Managers What do you need to thrive?

Registered Nurse or another relevant clinical qualification, including Doctor, PAM, RGN, SRN or ENG Excellent understanding of medical conditions, available treatments and medical specialities Strong clinical judgement with the ability to interpret complex information and make accurate claims decisions Excellent verbal and written communication skills, including confidence managing sensitive conversations by telephone Strong interpersonal and organisational skills with the ability to manage multiple complex cases effectively Good working knowledge of Microsoft Word and Excel Registered Complaint Handler or Private Medical Insurance/broader commercial healthcare knowledge would be advantageous So, what's in it for you?

Bonus Schemes – A bonus that regularly rewards you for your performance A pension of up to 12%– We will match your contributions up to 6% of your salary Our award-winning Vitality health insurance – With its own set of rewards and benefits Life Assurance – Four times annual salary These are just some of the many perks that we offer!

To view the extensive range of benefits we offer, please visit our careers page. Fantastic Benefits. Exciting rewards. Great career opportunities! If you are successful in your application and join us at Vitality, this is our promise to you, w e will:
Help you to be the healthiest you've ever been Create an environment that embraces you as you are and enables you to be your best self Give you flexibility on how,…