Enhanced Clinical Case Manager

Up to £50,000 per annum with London enhancement if appropriate (NHS band 7 equivalent)

We make health happen:

At Bupa, our UK Insurance clinical services are at an exciting time of growth and transformation, and we now have several amazing opportunities for both General Nurse to join our dynamic team of clinicians.

We are the only UK insurance provider recognised by the CQC and as an employer, we are values led with a proud track record of an open and inclusive culture. We are committed to investing in our people and support our team to access development opportunities.

Role Overview

Reporting to the Clinical Service Manager the post holder will provide a confident AND knowledgeable report. 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 preauthorise or decline treatment in line with policy coverage. 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 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.


• 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


• Identify and escalate concerns using Bupa UKI systems and processes including fraud, abuse and incidents
  
  Registered professional (Registered General Nurse, Registered Mental Health Nurse, Registered Physiotherapist)


• Valid NMC registration


• Ability to work independently within scope of practice and role requirements modelling own professional body and Bupa values of conduct and behaviour.


• 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 think analytically and solve problems to determine most appropriate eligible pathway for customers including eligibility of benefit.


• Excellent communication skills.


• 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.
  
  We're a health insurer and provider. With no shareholders, our customers are our focus. Our people are all driven by the same purpose - helping people live longer, healthier, happier lives and making a better world. We make health happen by being brave, caring and responsible in everything we do.


We encourage all of our people to "Be you at Bupa", we champion diversity, and we understand the importance of our people representing the communities and customers we serve. That's why we especially encourage applications from people with diverse backgrounds and experiences.

Our benefits are designed to make health happen for our people. Viva is our global wellbeing programme and includes all aspects of our health - from mental and physical, to financial, social and environmental wellbeing. We support flexible working and have a range of family friendly benefits.

Joining Bupa in this role you will receive the following benefits and more:

• 25 days holiday (pro-rata), 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 assurance


• Support with travel costs via a season ticket loan or cycle2work


• Performance-based bonus


• Onsite gyms or local discounts where no onsite gym available


• Various other benefits and online discounts


• Extensive internal and external training available for your CPD


• Clinical Leadership development programmes


• NMC fees paid after 12 months service


• Practical support with the revalidation process.


• Opportunities for career development around Bupa


• Option to join dental insurance scheme at a discounted rate


• Access to our Digital GP platform on your mobile


• Emotional wellbeing support


• Access to family mental health line


• Financial wellbeing channels


• Support for carers


"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."