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 ne...
Clinical Case Manager in Bournemouth employer: Vitality Corporate Services
Vitality is an exceptional employer that fosters a dynamic and inclusive work culture, offering flexible working arrangements to support a healthy work-life balance. As part of the Actuarial team in London, employees benefit from continuous professional development opportunities and the chance to collaborate with diverse stakeholders on innovative projects that drive the company's actuarial modelling capabilities forward. With a commitment to employee well-being and growth, Vitality stands out as a rewarding place to build a meaningful career.
Contact Details:
Vitality Corporate Services Recruitment Team
