Job Description:

Complex Clinical Case Manager

Bupa Angel Court/Bupa Willow House (Travel to London Hospitals will be required)

1 Angel Ct, London EC2R 7HJ / 4 Pine Trees, Chertsey Lane, Staines TW18 3DZ

Full time Permanent (37.5 hours per week)

Up to £48,000 per annum with London enhancement if appropriate (NHS AfC band 7 equivalent) + fantastic benefits

Here you’ll be welcomed. We champion diversity and we understand the importance of our people representing the communities and customers we serve. You’ll find an inclusive environment where you can be yourself and where everyone is driven by the same purpose – helping people live longer, healthier, happier lives and making a better world.

Bupa’s values , #brave #responsible #caring

Role Overview

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

The post holder is responsible for assessing 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. Operating within a CQC registered service the postholder is required to support meeting the following outcomes of the regulated area of UK Insurance (UKI).

What you'll do:

• Support for the whole customer pathway, proactively guiding, to maximise best outcomes and experience ensuring care is appropriate to need and eligible under policy using alternative treatment and pathways where appropriate

• Proactively manage queries and support customers, providers and colleagues onsite and remotely 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

• Work proactively with providers to support timely hospital discharge

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

• Maintain up to date and accurate knowledge of current best practice and clinical guidelines to ensure all decisions are appropriately made

• Use clinical skills to make decisions on highly complex treatment eligibility e.g. levels of care, hospital length of stay and treatment options

• 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

• 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

What you'll need:

• Registered professional (Registered General Nurse, Registered Mental Health Nurse, Registered Physiotherapist)

• Clinical experience across range of clinical condition areas

• 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 face to face or remotely with providers at all levels managing 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 interactions 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

• Excellent communication skills

• Ability to identify and be proactive in acting to quickly resolve problems, taking ownership to ensure speedy resolution with customers, providers and colleagues.

• Ability to make decisions based on the information gathered, within the guidelines/protocols set, but if this is not possible, they are responsible for providing a full case history to the Clinical Service Manager

Why Bupa?

We are a health insurer and provider. With no shareholders, our customers are our focus. We reinvest profits into providing more and better healthcare for the benefit of current and future customers.

“Bupa is a great place to work”, this is what Nikki Goodhew, Clinical Career Manager from Nurses.co.uk had to say when she worked with our great team of Clinicians;

“It is all about the clinicians, and their overall three core needs: autonomy, belonging and contribution. When people have these needs met and feel cared for and supported, they flourish. Flourishing people are a retained workforce, and this is one of the many reasons that Bupa UKI is a great place to work.”

To read more about Nikki’s impression, click on the link below

https://www.nurses.co.uk/blog/what-we-learned-about-compassionate-leadership-from-bupa/

Our benefits are driven by what matters to our people. It’s important to us that these benefits support a work-life balance that keeps people healthy, both mentally and physically. You will be eligible for:

· 25 days holiday, increasing through length of service, with option to buy or sell

· Bupa health insurance as a benefit in kind

· An enhanced pension plan and life insurance

· Annual performance-based bonus

· Onsite gyms or local discounts where no onsite gym available

· Various other benefits and online discounts

Diversity and Inclusion

Bupa is committed to making sure that every applicant is assessed solely on personal merit and qualifications. We actively celebrate the diversity of our colleagues and provide an inclusive environment so you can bring your true self to Bupa. We’ll make sure you are treated fairly. That’s why we’re happy to offer reasonable adjustments as part of our recruitment process to anyone that needs them.

Whether you’ve found your feet or are discovering a new path.

Welcome to a place that celebrates you.

This isn’t where you've been.

This is where you're going.

This is what we have belief in

Time Type:

Full time

Job Area:

Clinical Services