Case Manager - Healthcare Plan

Location: Tewkesbury/hybrid

Hours: Full Time

Salary: £24-27k

Purpose of the role

To provide an effortless journey for all members making claims via their company Healthcare Plan while always adhering to the respective Rules & Benefits.

Key Responsibilities

• Establish the current reason for ill health/injury and identify any underlying cause or contributory risk factors.
• Be instrumental in the multidisciplinary assessment process by ensuring information is gained sufficient to assess personal and occupational risk factors.
• Effectively communicate to the member the multifactorial issues associated with the current episode of ill health/injury and how they can personally address the risk factors within their control.
• Follow managed care pathways, NICE and evidence-based guidelines.
• Review both private and NHS options when making onward referrals for consultations, investigations, and treatment.
• Demonstrate a clear understanding of the Rules & Benefits for each individual plan and keep up to date with any changes/amendments made to these policies.
• Source appropriate treatment providers while adhering to guidelines outlined in the Rules & Benefits.
• Manage claims within the restraints of the Rules & Benefits.
• Ensure any escalations are managed using the appropriate processes and guidelines.
• Accurately record all information in CRM.
• Meet all legal compliance requirements and healthcare quality assurance standards.
• Demonstrate a professional and respectful approach during all interactions.
• Ensure that costs are managed to be fair and appropriate and no greater than regional averages.
• Work seamlessly with the onsite Functional Health Team to both take referrals and provide tasks for them to add a three-dimensional approach to the case.
• Maintain knowledge on all aspects of integrated health risk management.
• Take responsibility for recognition of any training needs in discussion with your Line Manager.
• Account for any errors including DPA breaches via prompt reporting to your Line Manager or other Senior Manager.
• Demonstrate entrepreneurial flair and best in class innovation.
• Undertake any other task as may reasonably be required by the company.
• Develop and sustain relationships with both internal and external customers.

Skills, Knowledge & Expertise

• Ability to use Microsoft Office including Word, Teams, Excel, Outlook, and PowerPoint.
• Demonstrate confident telephone skills using effective listening and empathy with employees and stakeholders, covering both inbound and outbound calls.
• Adopt an investigatory approach to cases to ensure that all obstacles are identified and removed where necessary.
• Demonstrate analytical and problem-solving skills.
• Ability to work confidently with little supervision while recognizing when to seek help or clarification.
• Understand the impact of work on an individual and the impact of ill health on an individual’s ability to work.
• Plan and control activities to meet objectives.
• Maintain productive working relationships.
• Manage workload effectively to meet customer deadlines and service standards.
• Demonstrate knowledge and adherence to healthcare performance and procedures standards.
• Understand clinical and non-clinical care pathways.
• Demonstrate knowledge of GDPR, DPA & ICO rules and guidelines relating to customers.
• Understand general occupational health and legal principles.
• Know the fundamentals of healthcare functional health practices.
• Effectively manage an integrated health approach to the prevention and management of workplace ill health/injury.
• Conduct telephone assessments and feedback using motivational interviewing or similar techniques.
• CBT principles and motivational interviewing techniques are also valuable skills for this role.

Qualifications & Experience – Ideal

• Qualified: physiotherapist, corrective exercise professional, counsellor, CBT practitioner, nutritionist, physiologist, nurse, or other appropriately qualified professional.
• HR, Sport & Exercise professional, or other similar professional.

Qualifications & Experience – Minimum

• English and Maths GCSE Grade C or above.
• Degree level education or equivalent professional certification or extensive relevant experience.
• Evidence ability to write clear and accurate English.

All successful candidates will be subject to DBS checks. HCML is committed to equality of opportunity for all staff and applications from individuals are encouraged regardless of age, disability, sex, gender reassignment, sexual orientation, pregnancy and maternity, race, religion or belief, and marriage and civil partnerships.