Clinical Case Manager (Pre-Authorisation)

• 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.

• 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.

• Registered with the NMC as an Adult Nurse, with substantial post-registration experience and demonstrable exposure to paediatric care.
• Due to the specialist oncology nature of this role, candidates must hold a current Systemic Anti-Cancer Therapy, SACT,Passport. Applications from candidates without this qualification cannot be considered.
• Extensive inpatient bedside nursing experience across both adult and paediatric services. Candidates must have hands-on clinical experience in both settings, not one or the other.
• Strong background in inpatient nursing or insurance sector in a clinical case management or utilisation review capacity.
• Senior-level clinical experience, typically at Band 6 or above, with demonstrable clinical leadership, service coordination, team supervision and/or management responsibilities.
• Proven ability to lead complex clinical decision-making, influence multidisciplinary teams and coordinate care across multiple stakeholders.
• Excellent verbal and written communication skills with the ability to build effective relationships across clinical, operational and insurer stakeholders

• 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

• Unique and Individual: We recognise and value everyone as unique and individual
• Kindness and compassion: We treat people with kindness and compassion
• Honesty, integrity and fairness: We act with absolute honesty, integrity and fairness
• Loyalty, respect and dignity: We trust and treat one another as valued members of the HCA UK family with loyalty, respect and dignity

• 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

Essential

• Registered with the NMC as an Adult Nurse, with substantial post-registration experience and demonstrable exposure to paediatric care.
• Due to the specialist oncology nature of this role, candidates must hold a current Systemic Anti-Cancer Therapy, SACT Passport. Applications from candidates without this qualification cannot be considered.
• Extensive inpatient bedside nursing experience across both adult and paediatric services. Candidates must have hands-on clinical experience in both settings, not one or the other.
• Strong background in inpatient nursing or insurance sector in a clinical case management or utilisation review capacity.
• Senior-level clinical experience, typically at Band 6 or above, with demonstrable clinical leadership, service coordination, team supervision and/or management responsibilities.
• Proven ability to lead complex clinical decision-making, influence multidisciplinary teams and coordinate care across multiple stakeholders.
• Excellent verbal and written communication skills with the ability to build effective relationships across clinical, operational and insurer stakeholders