Clinical Case Manager

VITALITY HEALTH LIMITED; Lower Blandford St Mary; Hybrid; GBP 45,000 - 65,000; Full time

Benefits offered by this job

Bonus schemes

Pension up to 12%

Vitality health insurance

Life assurance

Job summary

Vitality Health Limited is seeking a Clinical Case Manager for our Complex Care Team. The role focuses on managing long-term healthcare claims, including oncology cases, ensuring members receive appropriate benefits while delivering proactive care navigation and effective provider management.

You will assess eligibility, coordinate with providers, and support members through the treatment journey with clear, empathetic communication and sound clinical judgement.

Qualifications

• Registered Nurse or other relevant clinical qualification.
• Excellent understanding of medical conditions and treatments.
• Strong clinical judgement to interpret information and make accurate claims decisions.
• Excellent verbal and written communication skills, including handling sensitive conversations by phone.
• Strong interpersonal and organizational skills to manage multiple complex cases.

Responsibilities

• Manage a portfolio of complex, long-term healthcare claims and assess eligibility throughout treatment journeys.
• Provide supportive, clear communication to members and maintain regular contact during the claim.
• Analyse clinical and policy information to make accurate decisions within authority levels.
• Coordinate with consultants, hospitals and care providers for timely decisions.
• Guide members to appropriate treatment pathways and preferred providers.
• Identify and deliver sustainable claims savings through provider management and NHS cash benefits.

Skills

Clinical Case Management

Clinical Decision Making

Complex Care Navigation

Education

Registered Nurse

Tools

Microsoft Word

Microsoft Excel

Job description

About The Role

Team Complex Care

Working Pattern - Hybrid 2days 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 members 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 new Case Managers

What do you need to thrive?

• Registered Nurse or another relevant clinical qualification, including Doctor, PAM, RGN, SRN or ENG
• Excellent understanding of medical conditions, available treatments and medical specialities
• Strong clinical judgement with the ability to interpret complex information and make accurate claims decisions
• Excellent verbal and written communication skills, including confidence managing sensitive conversations by telephone
• Strong interpersonal and organisational skills with the ability to manage multiple complex cases effectively
• Good working knowledge of Microsoft Word and Excel
• Registered Complaint Handler orPrivate Medical Insurance/broader commercial healthcare knowledge would be advantageous

So, whats in it for you?

• Bonus Schemes A bonus that regularly rewards you for your performance
• A pension of up to 12% We will match your contributions up to 6% of your salary
• Our award-winning Vitality health insurance With its own set of rewards and benefits
• Life Assurance Four times annual salary

Fantastic Benefits. Exciting rewards. Great career opportunities!

These are just some of the many perks that we offer! To view the extensive range of benefits we offer, please visit our careers page.

If you are successful in your application and join us at Vitality, this is our promise to you, we will:

• Help you to be the healthiest youve ever been
• Create an environment that embraces you as you are and enables you to be your best self
• Give you flexibility on how, where and when you work
• Help you advance your career by playing you to your strengths
• Give you a voice to help our business grow and make Vitality a great place to be
• Give you the space to try, fail and learn
• Provide a healthy balance of challenge and support
• Recognise and reward you with a competitive salary and amazing benefits
• Be there for you when you need us
• Provide opportunities for you to be a force for good in society

We commit to all these things because we want you to feel that you belong, and are supported to be happy and healthy.

About The Company

Were incredibly proud to be recognised for the culture we've created recently being named one of Glassdoors Best Places to Work 2026, and in 2024 we were delighted to be awarded Top 10 Places to Work in the Sunday Times Awards.

Vitality is a multi-award-winning UK insurance brand, here to make the world a healthier, happier place.

Weve been a purpose and values-driven business from day 1- long before it became fashionable. Our core purpose is to make people healthier and enhance protect their lives. Vitality pioneered shared-value insurance. We incentivise people to live healthier longer lives they benefit, our business benefits, and society benefits. Were successful because we attract, develop, and retain the best people and because we care.

Plus, you get to join our 1.7+ million members with access to our unique health insurance and healthy living programme. Just to make sure you know our products inside and out.

Ready to find out if were the right fit for you? We cant wait.

Diversity & Inclusion

At Vitality, were committed to diversity and inclusion because its good for our employees, for our business, and for society. We welcome applications from individuals of all backgrounds, experiences, and perspectives.

Vitalitys approach to sustainability

Vitality is a business that drives positive change. We reward people for making and sustaining healthier choices. But healthy people also need a healthy environment. To learn more please visit our Careers page.