Hybrid Clinical Case Manager: Complex Care Navigator

Vitality; Bournemouth; Hybrid; GBP 35,000 - 52,000; Full time

Benefits offered by this job

Bonus schemes

Pension up to 12% matched

Vitality health insurance

Life Assurance

Job summary

Vitality is actively seeking a Clinical Case Manager to join the Complex Care Team in the UK. This role focuses on managing long-term, complex healthcare claims, including oncology cases, while ensuring members access benefits and treatments under their plan.

You will use clinical expertise to navigate care pathways, support providers, and make informed claims decisions. You will collaborate with consultants, hospitals, and other care providers to collect information, communicate with members,

Qualifications

• Registered Nurse or another clinical qualification.
• Strong clinical judgement with ability to interpret complex information.
• Excellent verbal and written communication with stakeholders.

Responsibilities

• Manage a portfolio of complex, long-term healthcare claims, assessing eligibility throughout treatment journey.
• Provide compassionate support to members and explain the case management process.
• Analyse information to make accurate decisions within authority levels and claims positions.
• Coordinate with consultants, hospitals and care providers for timely decisions.
• Guide members to appropriate treatment paths and preferred providers.
• Identify ways to deliver sustainable claims savings through provider management and NHS benefits.
• Maintain accurate records of member contact, assessments and decisions.
• Contribute to audits, projects and development of Complex Care processes.
• Support team capability through mentoring and training of new Case Managers.

Skills

Clinical Case Management

Clinical Decision Making

Complex Care Navigation

Education

Registered Nurse

Tools

Microsoft Word

Microsoft Excel

Job description

Vitality is actively seeking a Clinical Case Manager to join the Complex Care Team in the UK. This role focuses on managing long-term, complex healthcare claims, including oncology cases, while ensuring members access benefits and treatments under their plan.

You will use clinical expertise to navigate care pathways, support providers, and make informed claims decisions. You will collaborate with consultants, hospitals, and other care providers to collect information, communicate with members,