Clinical Case Manager (Mental Health)

Salford Quays / London – hybrid with 1 day a week on site

Permanent

Full time - 37.5 hours per week

£36,500

We try to consider all types of flexibility, including locations, hours and working patterns.

We make health happen:

As a Clinical Case Manager, you will provide a confident, knowledgeable and efficient front-line service to our Bupa customers and providers via inbound and outbound calls, and administratively including signposting to enable customer access to eligible services through their Bupa policy.
 
You'll be responsible for ensuring eligibility for the customer to use their policy
and preauthorise or decline treatment in line with policy coverage and ensuring the customer is on the most suitable treatment pathway. The post holder will also contribute to effective clinical, commercial, and operational performance within their area and ensure the optimisation of capacity and capability. 

How you'll help us make health happen:

• Respond to queries and support members, providers, and colleagues via phone, email, letter, and UKI systems.
• Explain treatment authorisation, declines, and benefit entitlements.
• Maintain accurate knowledge of Bupa products, policies, and initiatives to answer queries correctly.
• Interpret Bupa UKI policy and rules, using correct codes for accurate data processing.
• Use Bupa systems and software proficiently, ensuring compliance with UKI data protection and regulation requirements. Maintain accurate customer clinical records.
• Guide customers and providers to ensure correct treatment per policy terms. Identify opportunities to reduce future claim expenses.
• Serve as an escalation point for clinically complex cases and provide clinical case management support.
• Identify and escalate concerns, such as fraud and incidents, using Bupa UKI systems. Contribute to solutions for improving business performance and customer experience.
• Support colleagues by sharing information and knowledge.
• Maintain up-to-date records of daily activities for reporting.
• Achieve personal and team KPIs.

Key Skills / Qualifications needed for this role:

• A Registered Mental Health Nurse (RMN) qualification is essential
• 5 years + experience in CAMHS and/or working with young people is essential
• Experience working with neurodivergent individuals is desirable
• Risk management experience and good knowledge of safeguarding
• Can work effectively as part of a team and also independently
• Calm and professional handling of complex and challenging conversations
• Resilient in high-pressure environments with emotional or vulnerable customers
• A confident, mature, and compassionate telephone manner with effective conversation and listening skills
• Analytical problem-solving to determine appropriate customer pathways and benefit eligibility
• PC literate with a familiarity of CRM systems

Benefits

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.

• 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
• Onsite gyms or local discounts where no onsite gym available
• Various other benefits and online discounts

Why Bupa?

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.

Bupa is a Level 2 Disability Confident Employer. This means we aim to offer an interview/assessment to every disabled applicant who meets the minimum criteria for the role. We'll make sure you are treated fairly and offer reasonable adjustments as part of our recruitment process to anyone that needs them.

If you require information regarding this role in an alternative format, please email: careers@bupa.com