Medical Case Manager Rn

We have two opening for a Medical Case Manager position at Healix Health in our Bristol-based office.

Reporting to the Clinical Lead, the Case Manager (CM) will be responsible for their own caseload, providing proactive case management of high cost and complex claims (HCCCs) in liaison with all members of the healthcare team, the patient and the client. The CM will ensure that all parties have the relevant information and the member receives appropriate medical information and access to required medical services within the terms of their plan/policy, through the incorporation of NHS navigation options and cost-containment measures as standard.

We are looking for candidates who meet the following criteria:

· A good understanding and previous experience of the private medical insurance industry and claims processing, would be an advantage

· The ability to work well both independently and as part of a team

· Good problem solving and analytical skills

· Good commercial awareness with the ability to make decisions with the "bigger picture" in mind

· An overall external awareness of new technology or development within the medical sector to pre-empt and be prepared for possible related queries

· Able to interpret medical reports, write reports and other professional correspondence

· Strong diplomatic communicator at all levels; verbally and written to build and maintain internal and external relationships

· Able to demonstrate critical independent thinking and the ability to multi-task in situations where in the outcome is time sensitive.

· A high degree of accuracy and attention to detail.

· PC skills with good knowledge of Microsoft packages and the ability to effectively manage computer technology, typing and word processing.

About The Role

Key activities/main duties:

Case Management

· Maintain own caseload, ensuring a proactive case management approach through regular communication with the member, specialist and client (if appropriate)

· Using the Case Management System (CMS) for all aspects of case management

· Arrange care with an appropriate medical team / medical facility, utilising a directional approach to ensure quality and cost effectiveness of treatment

Operational

· Responsible for the provision of an efficient, cost effective and customer focused service to clients and members

· Assess eligibility of treatment within the plan/policy terms and conditions, ensuring correct processes are followed for declines, shortfalls and complaints (including in accordance with FCA regulations where appropriate)

Clinical

· Ability to liaise with clinicians (both internally and externally) to make accurate assessments based on the information provided to manage cases efficiently and ensure the very best care plan is established for members

· Provide guidance and support to the non-clinical teams to ensure members receive timely and accurate cover decisions, allowing them to progress with their treatment

Required Criteria

• Registered Nurse or Paramedic

Desired Criteria

• Case Management Experience
• Good understanding and previous experience of the private medical insurance industry and claims processing

Skills Needed

Company Culture

Instead, we focus on ensuring our highly trained specialists have the space and time they need to be effective. We let them use their initiative to get the job done, because the situations they face often throw up unexpected challenges - and no protocol survives contact with the real world.

Our clients have thousands of employees and customers, at home and abroad, so they need a business big enough to handle any situation. But they chose Healix because they also need an organisation that’s personal enough to care.

Our people are driven to do things in the best way, not the way they have always been done. We work hard, and our efforts are rewarded with great development opportunities and a supportive team spirit.

We want to nurture this friendly and dynamic company culture so that we can continue to attract diverse talent with a breadth of knowledge and world-class skills. As a part of Healix, you can expect a range of excellent benefits and an environment where people really do care.

Company Benefits

Commitment to career development

We are committed to helping our people build and develop successful careers. Our employees are given direct responsibility and opportunity to develop and grow whilst working on challenging and worthwhile projects in a rewarding and supportive environment.

We invest in the continuous development of our team, offering on-going training and professional enhancement opportunities for those wishing to diversify or take additional responsibilities.

Health insurance, Vacation, Paid time off, Retirement plan and/or pension, Office perks, Employee development programs, Employee discounts, Gym membership or wellness programs, Opportunity to travel, Casual dress, Cycle to work, Open office, Competitive salary, Life insurance, Employee Assistance Scheme, Wellbeing Scheme, Social Opportunities, Hybrid Working

Salary

£40,000.00 - £42,000.00 per year