Job Description:
Clinical Case Manager (Mental Health)
Salford Quays / London –
Permanent
Full time -
£36,500
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:
1. Respond to queries and support members, providers, and colleagues via phone, email, letter, and UKI systems.
2. Explain treatment authorisation, declines, and benefit entitlements.
3. Maintain accurate knowledge of Bupa products, policies, and initiatives to answer queries correctly.
4. Interpret Bupa UKI policy and rules, using correct codes for accurate data processing.
5. Use Bupa systems and software proficiently, ensuring compliance with UKI data protection and regulation requirements. Maintain accurate customer clinical records.
6. Guide customers and providers to ensure correct treatment per policy terms. Identify opportunities to reduce future claim expenses.
7. Serve as an escalation point for clinically complex cases and provide clinical case management support.
8. Identify and escalate concerns, such as fraud and incidents, using Bupa UKI systems. Contribute to solutions for improving business performance and customer experience.
9. Support colleagues by sharing information and knowledge.
10. Maintain up-to-date records of daily activities for reporting.
11. Achieve personal and team KPIs.
Key Skills / Qualifications needed for this role:
12. A Registered Mental Health Nurse (RMN) qualification is essential
13. 5 years + experience in CAMHS and/or working with young people is essential
14. Experience working with neurodivergent individuals is desirable
15. Risk management experience and good knowledge of safeguarding
16. Can work effectively as part of a team and also independently
17. Calm and professional handling of complex and challenging conversations
18. Resilient in high-pressure environments with emotional or vulnerable customers
19. A confident, mature, and compassionate telephone manner with effective conversation and listening skills
20. Analytical problem-solving to determine appropriate customer pathways and benefit eligibility
21. 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.
22. 25 days holiday, increasing through length of service, with option to buy or sell
23. Bupa health insurance as a benefit in kind
24. An enhanced pension plan and life insurance
25. Onsite gyms or local discounts where no onsite gym available
26. 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.