Healthcare Specialist

3 weeks ago


Tewkesbury, Gloucestershire, United Kingdom Hcml Today Full time

About the Role:

Hcml Today seeks a skilled Healthcare Specialist to join its team. This is a full-time position based in Tewkesbury/hybrid, with an estimated salary of £24-27k.

As a Case Manager, you will be responsible for providing an effortless journey for members making claims via their company Healthcare Plan while adhering to the respective Rules & Benefits.

This role requires you to establish the current reason for ill health/injury and identify any underlying cause or contributory risk factors. You will work closely with the onsite Functional Health Team to take referrals and provide tasks for them to add a three-dimensional approach to the case.

You will need to effectively communicate with members about multifactorial issues associated with their current episode of ill health/injury and how they can personally address the risk factors within their control. Following managed care pathways, NICE and evidence-based guidelines, you will review private and NHS options when making onward referrals for consultations, investigations, and treatment.

To succeed in this role, you must demonstrate a clear understanding of the Rules & Benefits for each individual plan and stay up-to-date with changes/amendments made to these policies. You will source appropriate treatment providers while adhering to guidelines outlined in the Rules & Benefits and manage claims within these restraints.

You will also ensure that costs are managed to be fair and appropriate and no greater than regional averages. The ideal candidate will have qualifications such as physiotherapist, corrective exercise professional, counsellor, CBT practitioner, nutritionist, physiologist, nurse, or other appropriately qualified professional, along with English and Maths GCSE Grade C or above, degree level education or equivalent professional certification, and extensive relevant experience.

Key Responsibilities:

  • Establish the current reason for ill health/injury and identify any underlying cause or contributory risk factors.
  • Work closely with the onsite Functional Health Team to take referrals and provide tasks for them to add a three-dimensional approach to the case.
  • Effectively communicate with members about multifactorial issues associated with their current episode of ill health/injury and how they can personally address the risk factors within their control.
  • Follow managed care pathways, NICE and evidence-based guidelines.
  • Review private and NHS options when making onward referrals for consultations, investigations, and treatment.
  • Demonstrate a clear understanding of the Rules & Benefits for each individual plan and stay up-to-date with changes/amendments made to these policies.
  • SOURCE APPROPRIATE TREATMENT PROVIDERS WHILE ADHERING TO GUIDELINES OUTLINED IN THE RULES & BENEFITS.
  • MANAGE CLAIMS WITHIN THESE RESTRAINTS.
  • Evaluate the impact of work on an individual and the impact of ill health on an individual's ability to work.
  • Plan and control activities to meet objectives.
  • Maintain productive working relationships.
  • Manage workload effectively to meet customer deadlines and service standards.

Required Skills and Qualifications:

  • Ability to use Microsoft Office including Word, Teams, Excel, Outlook, and PowerPoint.
  • Demonstrate confident telephone skills using effective listening and empathy with employees and stakeholders, covering both inbound and outbound calls.
  • Adopt an investigatory approach to cases to ensure that all obstacles are identified and removed where necessary.
  • Demonstrate analytical and problem-solving skills.
  • Ability to work confidently with little supervision while recognizing when to seek help or clarification.
  • Demonstrate knowledge and adherence to healthcare performance and procedures standards.
  • Understand clinical and non-clinical care pathways.
  • Demonstrate knowledge of GDPR, DPA & ICO rules and guidelines relating to customers.
  • Understand general occupational health and legal principles.
  • Know the fundamentals of healthcare functional health practices.
  • Effectively manage an integrated health approach to the prevention and management of workplace ill health/injury.
  • Conduct telephone assessments and feedback using motivational interviewing or similar techniques.
  • Candidates with qualifications such as physiotherapist, corrective exercise professional, counsellor, CBT practitioner, nutritionist, physiologist, nurse, or other appropriately qualified professional will be preferred.


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