Case Management Nurse

Healix Health; West of England; On-site; GBP 36,000 - 54,000; Full time

Job summary

Healix Health is seeking a Clinical Case Manager to join our team. You will support members through their healthcare journeys, coordinating treatment pathways with providers and delivering high-quality, cost-effective care.

The role involves managing a caseload, reviewing costs, and guiding patients on claims and options. The ideal candidate is an RN or HCPC-registered professional with at least two years’ clinical experience, strong assessment skills, and a customer-focused approach.

Qualifications

• Registered Nurse with active professional registration (NMC) or Allied Health Professional with HCPC registration.
• Minimum of two years’ clinical experience.
• Experience in case management, healthcare funding or healthcare claims is desirable.
• Strong clinical assessment and decision-making skills.
• Excellent communication and relationship-building abilities.

Responsibilities

• Manage your own caseload with a proactive, member-focused approach to case management.
• Liaise with healthcare providers, consultants and treating clinicians to coordinate treatment and care.
• Monitor treatment plans and ensure care remains clinically appropriate and aligned to members’ needs.
• Support discharge planning and ongoing care arrangements.
• Review healthcare costs and treatment pathways for value and oversight.
• Assess treatment eligibility in line with scheme terms and conditions.
• Maintain accurate case records using the Case Management System.
• Provide guidance to members on healthcare claims and treatment options.
• Conduct Health Needs Assessments and provide wellbeing guidance and signposting.
• Offer clinical expertise to internal stakeholders and non-clinical teams.
• Contribute to service development and clinical training initiatives.

Skills

Clinical assessment

Case management

Communication

Organisational skills

IT skills

Education

NMC Registration (RN)

HCPC Registration

Tools

Case Management System

Microsoft Office

Job description

Are you a Registered Nurse or Allied Health Professional looking for a rewarding role where you can combine your clinical expertise with case management and member support?

At Healix Health, we're looking for a registered Nurse to join our experienced team, supporting members through their healthcare journeys while ensuring access to high-quality, clinically appropriate and cost-effective care. This is an opportunity to make a real difference by guiding individuals through treatment pathways, liaising with leading healthcare providers, and delivering exceptional customer outcomes.

Working closely with members, families, clinicians, healthcare providers, clients and internal teams, you will manage a varied caseload and play a key role in delivering a first-class healthcare funding and case management service.

About this role

What You'll Be Doing

As a Clinical Case Manager, you will:

• Manage your own caseload, taking a proactive and member-focused approach to case management.
• Liaise with healthcare providers, consultants and treating clinicians to coordinate appropriate treatment and care.
• Monitor treatment plans and progress, ensuring care remains clinically appropriate and aligned to members' needs.
• Support discharge planning and ongoing care arrangements.
• Review healthcare costs and treatment pathways to ensure value and effective financial oversight.
• Assess treatment eligibility in line with scheme terms and conditions.
• Maintain accurate case records and documentation using our Case Management System.
• Provide support and guidance to members regarding healthcare claims and treatment options.
• Conduct Health Needs Assessments and provide wellbeing guidance, support and signposting where appropriate.
• Offer clinical expertise and advice to internal stakeholders and non-clinical teams.
• Contribute to service development, process improvement initiatives and clinical training activities.

What We're Looking For

• Registered Nurse (RN/RMN) with current professional registration and a minimum of two years' clinical experience; or
• Allied Health Professional with current HCPC registration and a minimum of two years' experience.
• Strong clinical assessment and decision-making skills.
• Excellent communication and relationship-building abilities.
• Ability to manage a varied workload and prioritise effectively.
• Strong attention to detail and organisational skills.
• Customer-focused approach with a commitment to delivering excellent service.
• Good IT skills, including Microsoft Office and digital case management systems.
• Experience within case management, healthcare funding or healthcare claims.
• Knowledge of private medical insurance and claims processes.
• Understanding of healthcare funding pathways and provider networks.

You’ll thrive in this role if you’re clinically credible, commercially aware and passionate about helping people navigate complex healthcare journeys. You’ll enjoy building relationships, solving problems and working collaboratively to deliver outstanding outcomes for members and clients alike.