Medical Case Manager
Medical Case Manager
Are you a Registered Nurse or Allied Health Professional looking for a rewarding role where you can combine your clinical expertise with case management and member support?
At Healix Health, we're looking for a Clinical Case Manager to join our experienced team, supporting members through their healthcare journeys while ensuring access to high-quality, clinically appropriate and cost-effective care. This is an opportunity to make a real difference by guiding individuals through treatment pathways, liaising with leading healthcare providers, and delivering exceptional customer outcomes.
Working closely with members, families, clinicians, healthcare providers, clients and internal teams, you will manage a varied caseload and play a key role in delivering a first-class healthcare funding and case management service.
About this role
What You'll Be Doing
As a Clinical Case Manager, you will:
Manage your own caseload, taking a proactive and member-focused approach to case management.
Liaise with healthcare providers, consultants and treating clinicians to coordinate appropriate treatment and care.
Monitor treatment plans and progress, ensuring care remains clinically appropriate and aligned to members' needs.
Support discharge planning and ongoing care arrangements.
Review healthcare costs and treatment pathways to ensure value and effective financial oversight.
Assess treatment eligibility in line with scheme terms and conditions.
Maintain accurate case records and documentation using our Case Management System.
Provide support and guidance to members regarding healthcare claims and treatment options.
Conduct Health Needs Assessments and provide wellbeing guidance, support and signposting where appropriate.
Offer clinical expertise and advice to internal stakeholders and non-clinical teams.
Contribute to service development, process improvement initiatives and clinical training activities.
What We're Looking For
Essential
Registered Nurse (RN/RMN) with current professional registration and a minimum of two years' clinical experience; or
Allied Health Professional with current HCPC registration and a minimum of two years' experience.
Strong clinical assessment and decision-making skills.
Excellent communication and relationship-building abilities.
Ability to manage a varied workload and prioritise effectively.
Strong attention to detail and organisational skills.
Customer-focused approach with a commitment to delivering excellent service.
Good IT skills, including Microsoft Office and digital case management systems.
Desirable
Experience within case management, healthcare funding or healthcare claims.
Knowledge of private medical insurance and claims processes.
Understanding of healthcare funding pathways and provider networks.
You'll thrive in this role if you're clinically credible, commercially aware and passionate about helping people navigate complex healthcare journeys. You'll enjoy building relationships, solving problems and working collaboratively to deliver outstanding outcomes for members and clients alike.
What you will need
Required criteria
- Registered Nurse or Paramedic
Desired criteria
- Case Management Experience
- Good understanding and previous experience of the private medical insurance industry and claims processing
