Clinical Case Manager - Registered Nurse (bupa)

Job Description

Job Description:

Clinical Case Manager - Registered Nurse

Bupa Place - 102 The Quays, Manchester M50 3SP 

Angel Court - 1 Angel Ct, London EC2R 7HJ

(Can be based out of either office - Hybrid Working)

Full Time Permanent - 37.5 hours per week

£34,500 - £41,500 per annum dependent upon experience and qualifications

We make health happen

Reporting to the Clinical Team Manager the post holder will provide a confident, knowledgeable and efficient front-line service to our Bupa customers and providers via telephony (inbound and outbound) and administratively including signposting to enable customer access to eligible services through their Bupa policy.

The post holder is responsible for ensuring eligibility for the customer to use their policy and pre authorise or decline treatment in line with policy coverage and ensuring the customer is on the most suitable treatment pathway

The post holder will contribute to effective clinical, commercial, and operational performance within their area and ensure the optimisation of capacity and capability.

How you’ll help us make health happen:

• Proactively respond to queries and support members, providers and colleagues via e.g. telephone, email, letter and UKI systems to advise on the decision of requests including treatment authorisation and decline and fully explain benefit entitlement

• Maintain up to date and accurate knowledge of appropriate Bupa products, policies, and initiatives in order to ensure that all queries are answered accurately

• Correctly interpret Bupa UKI policy and rules, using the correct compatible combinations of codes for accurate processing of data, in accordance with our service standards and customer expectations

• Utilise Bupa systems and software proficiently as required by the role and in line with UKI data protection and regulation requirements including maintain accurate customer clinical records in appropriate system meeting own professional standards e.g. NMC/HCPC

• Proactively guide customers and providers to ensure customers receive the correct treatment available as eligible with their policy terms and conditions and where possible identify opportunities to reduce future claim expense for Bupa UKI e.g. using alternative treatments and pathways

• Escalation point for other business areas for clinically complex cases and clinical case management support

• Identify and escalate concerns using Bupa UKI systems and processes including e.g. fraud, abuse and incidents contributing to identifying solutions that will improve business performance and customer experience

• Utilise Bupa systems and software proficiently as required by the role and in line with UKI data protection and regulation requirements

• Proactively support colleagues in sharing information and knowledge.

• Maintain up to date records of own daily activity for reporting

Key Skills / Qualifications needed for this role:

• Registered professional (Registered General Nurse, Registered Mental Health Nurse, Physiotherapist) - with experience in Oncology

• Ability to work independently within scope of practice and role requirements modelling own professional body and Bupa values of conduct and behaviour

• Previous Contact Centre experience desirable

• Ability to deal calmly and professionally with providers and customers including manging complex and challenging conversations

• Resilient and able to keep difficult conversations and challenges in perspective in a pressured environment particularly where there are high emotions and/or vulnerable, anxious, and worried customers

• Ability to handle telephone calls with knowledge, confidence, maturity, compassion, and tact with a tailored approach through effective conversation and listening skills, balancing great customer service delivery with efficient performance

• Ability to think analytically and solve problems to determine most appropriate eligible pathway for customers including eligibility of benefit

Our benefits are designed to make health happen for our people. Viva is our global wellbeing programme and includes all aspects of our health – from mental and physical, to financial, social and environmental wellbeing. We support flexible working and have a range of family friendly benefits.

Joining Bupa in this role you will receive the following benefits and more:

• 25 days holiday per year, pro rata to your contract.

• Access to a range of services to support your physical and mental wellbeing

• Access to our confidential employee assistance programme

• Workplace pension

• Online discounts covering your everyday shopping, entertainment, eating out and more.

Why Bupa?

We’re a health insurer and provider. With no shareholders, our customers are our focus. Our people are all driven by the same purpose – helping people live longer, healthier, happier lives and making a better world. We make health happen by being brave, caring and responsible in everything we do.

We encourage all of our people to “Be you at Bupa”, we champion diversity, and we understand the importance of our people representing the communities and customers we serve. That’s why we especially encourage applications from people with diverse backgrounds and experiences.

Bupa is a Level 2 Disability Confident Employer. This means we aim to offer an interview/assessment to every disabled applicant who meets the minimum criteria for the role. We’ll make sure you are treated fairly and offer reasonable adjustments as part of our recruitment process to anyone that needs them.

If you require information regarding this role in an alternative format, please email: careers@bupa.com

Time Type:

Full time

Job Area:

Clinical Services

Locations:

Angel Court, London, Bupa Place