Clinical Case Manager; Pre-Authorisation

Location:

Leaders in Oncology Care, London
This role is based fully on site
Full time, 37.5 hours per week
Monday to Friday, with a choice of 8am-4pm or 9am-5pm
Permanent contract
Salary:
Competitive

We’re looking for a Clinical Case Manager (Pre-Authorisation) to join our Case Management team. This opportunity is ideally suited to an experienced Band 6 (or equivalent) nurse or healthcare professional with extensive inpatient bedside nursing experience across both adult and paediatric care, or a senior nurse with a strong background within the healthcare insurance sector. You’ll bring the confidence to make complex clinical decisions, challenge where appropriate, and work collaboratively with consultants, nursing teams, insurers and operational stakeholders to ensure patients receive safe, timely and cost-effective care throughout their healthcare journey.

As a Clinical Case Manager, you’ll use your clinical expertise to assess pre-authorisation requests for complex treatments including chemotherapy, radiotherapy and bone marrow transplant cases, ensuring all reviews are completed in line with national standards, evidence-based practice and contractual requirements. Working collaboratively across multidisciplinary teams, you’ll influence patient care pathways, provide clinical guidance to non-clinical colleagues and help drive quality, efficiency and patient satisfaction.

Above all else, we’re committed to the care and improvement of human life. It’s this guiding vision that influences everything we do at HCA UK. From the CEO to the colleagues on the floor we all have a part to play in delivering exceptional care to our patients. Other’s may think this is just a role in Case Management, but to us, you’ll be part of a wider team with a unique sense of purpose, one that helps improve lives on a daily basis.

• Manage pre-authorisation requests for complex treatments and ensure timely completion in line with contractual requirements.
• Conduct clinical reviews using nationally recognised, evidence-based standards and elevate cases where appropriate.
• Assess medical necessity and level of care requirements, making recommendations to Physicians and Medical Directors.
• Collaborate with clinical teams, provider networks and third-party payors to coordinate patient treatment plans and authorisations.
• Maintain accurate clinical documentation, support audit activity and contribute to quality improvement initiatives.

• Registered with the NMC as an Adult Nurse, with substantial post-registration experience and demonstrable exposure to paediatric care.
• Extensive inpatient bedside nursing experience across both adult and paediatric services. (Candidates must have hands-on clinical experience in both settings, not one or the other.)
• Strong background in inpatient nursing or insurance sector in a clinical case management or utilisation review capacity.
• Senior-level clinical experience, typically at Band 6 or above (or equivalent), with demonstrable clinical leadership, service coordination, team supervision and/or management responsibilities.
• Proven ability to lead complex clinical decision-making, influence multidisciplinary teams and coordinate care across multiple stakeholders.
• Excellent verbal and written communication skills with the ability to build effective relationships across clinical, operational and insurer stakeholders

Originally founded over 50 years ago by Dr Thomas Frist, HCA has gone on to become one of the world’s leading healthcare providers. In the UK, we’re one of the largest providers of privately funded healthcare and have invested over £500 million in the latest treatments, technology, techniques, medication and…