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Registered Nurse

Employer
Healix International
Location
South East England
Salary
Competitive Salary
Closing date
21 May 2021

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Job Details

Healix Health Services provides an expert, nurse-led experience for customers who are undergoing treatment covered under their private healthcare.  We provide unrivalled medical expertise at every step so our customers can be confident they are receiving the very best care.

Reporting to the Clinical Lead, our nurses are responsible for their own caseload, providing proactive case management of high cost complex claims in liaison with all members of the healthcare team, the patient and the client.  From ensuring all parties have the relevant information and the member receives appropriate medical information, to assessing required medical services within the terms of their plan/policy, through the incorporation of NHS navigation options and cost-containment measures as standard. 

We are currently looking for a proactive, analytical and diligent registered nurse to join our claims management team to handle high cost, complex cases.  Key activities include:

  • Remotely assessing and managing treatment plans whilst liaising with hospitals, specialist teams and the client, in line with the terms of the policy
  • Ensuring that treatment delivered is appropriate at all times by monitoring treatment plans and progress.
  • Liaising with medical teams to arrange care and utilising a directional approach to ensure quality and cost effective treatment.
  • Monitoring treatment progress and liaising with the patient to ensure they are discharged to an appropriate environment in a timely manner
  • Anticipating treatment pathways and likely costs, in advance of the treatment to assist with cost-containment measures
  • Maintaining high cost notifications for own caseload, ensuring these are kept updated in real time and the relevant parties are informed of any changes
  • Providing expert guidance to non-clinical members team to ensure members receive timely and accurate cover decisions
  • Answering calls and emails from members in relation to claims or enquiries
  • Assessing eligibility of treatment within the policy and conditions, ensuring correct processes and followed for declines, shortfalls and complaints.
  • Gathering accurate and salient facts in relation to a case to provide specific clinical advice
  • Liaise confidently and appropriately with the Healix Medical Team for the review of claims and assessment of treatment modalities
  • Assess and evaluate new procedures and technologies to ensure members continue to receive the most appropriate medical care within the terms of their policies/plans
  • Maintain up to date knowledge of clinical practice and use this to ensure the department acts in accordance with best clinical practice and current methods of healthcare delivery

Work 35 hours per week, Monday to Friday, covering the hours between 8am and 6pm.  No night or weekend shifts.

Key requirements for a Claims Specialist Nurse (RN)

  • Registered nurse, with NMC membership
  • Recent clinical experience and solid clinical knowledge
  • Good problem solving skills and ability to analyse medical reports
  • Effective time management skills, with the ability to prioritise and multi-task
  • Strong interpersonal skills with a diplomatic style to communication
  • Excellent attention to detail and able to work with a high degree of accuracy
  • Good computer skills, confident in using Microsoft packages

What we offer

The Healix culture is warm and friendly, we are proud of our working environment and our loyal and dedicated employees. We employ high quality and experienced professionals from within the medical, travel insurance and assistance professions. We are also pleased to offer career development opportunities for those wishing to diversify or take additional responsibilities.

To Apply, please email careers@healix.com

Company

Healix help people when they need it most – from offering sound medical advice and putting together long-term treatment plans, to carrying out international medical repatriations. We’re co-ordinators and problem-solvers: experts at navigating the global health landscape, operating on the leading edge of medical case management.

Our focus is on ensuring our expert team of doctors, nurses and co-ordinators have the confidence, time and tools they need to make the best call in each unique circumstance, trusting in their skills and experience to put the health and wellbeing of our customers first.

 

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