Description
We're looking for a Clinical Case Manager - Pre-Authorisation to join our Case Management team. This opportunity is ideally suited to an experienced Band 6 nurse or healthcare professional with extensive inpatient bedside nursing experience across both adult and paediatric care, or a senior nurse with a strong background within the healthcare insurance sector.
As a Clinical Case Manager, you'll use your clinical expertise to assess pre-authorisation requests for complex treatments including chemotherapy, radiotherapy and bone marrow transplant cases, ensuring all reviews are completed in line with national standards, evidence-based practice and contractual requirements.
Main duties of the job:
- Manage pre-authorisation requests for complex treatments and ensure timely completion in line with contractual requirements.
- Conduct clinical reviews using nationally recognised, evidence-based standards and escalate cases where appropriate.
- Assess medical necessity and level of care requirements, making recommendations to Physicians and Medical Directors.
- Collaborate with clinical teams, provider networks and third-party payors to coordinate patient treatment plans and authorisations.
- Maintain accurate clinical documentation, support audit activity and contribute to quality improvement initiatives.
Benefits:
- 25 days holiday each year, plus bank holidays, increasing with service, with option to buy or sell leave to suit you
- Private Healthcare Insurance for treatment at our leading hospitals
- Private pension contribution which increases with length of service
- Season Ticket Loan and Cycle to Work scheme
- Group Life Assurance from day one
- Critical illness cover
- Enhanced Maternity and Paternity pay
- Corporate staff discount for all facilities including Maternity packages at The Portland
- Comprehensive range of flexible health, protection and lifestyle benefits to suit you
- Discounts with over 800 major retailers