Clinical Case Manager

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, we 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, where and when you work
• Help you advance your career by playing you to your strengths
• Give you a voice to help our business grow and make Vitality a great place to be
• Give you the space to try, fail and learn
• Provide a healthy balance of challenge and support
• Recognise and reward you with a competitive salary and amazing benefits
• Be there for you when you need us
• Provide opportunities for you to be a force for good in society

We commit to all these things because we want you to feel that you belong, and are supported to be happy and healthy.