Clinical Case Manager: Complex Care Navigator (Hybrid)

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

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.