Musculoskeletal Service Lead

Salary Unspecified
Town/City Esher KT10 8AB
Payment type Per annum
Region London
Contract type Permanent contract
Closing date
Hours Full-time
Type of employer Private provider
Name of employer Healix Health Services

Other benefits

Vacancy details

The Company

Healix Health Services is part of the Healix Group of Companies which has provided healthcare and risk management solutions to clients around the world since 1992, offering bespoke services to clients wanting control over their health, travel and risk provision.

We act as a third-party medical claims administrator in the UK for domestic and international insurers as well as for UK Healthcare Trusts which are self-insured corporate healthcare schemes managed on behalf of employers for their employees.  We supply high quality case management services for both early intervention and self-funded medical schemes and have long established relationships with leading hospitals and healthcare professionals throughout the UK. We have won the ‘Best Healthcare Trust Provider Award’ in the prestigious annual Health Insurance Awards eight times over the last nine years.

The Role

Reporting to the Director of Operations, the MSK Clinical Lead will be responsible for leading and coordinating the development of the MSK strategy for HHS. The holder of this role will be supported by the Head of Clinical Development and Head of Clinical Services. The prime aim is to provide highly specialist clinical expertise in supporting the delivery of high standards of clinical MSK services to our members.   This will be achieved through continuing improvements to our MSK services in terms of clinical effectiveness and efficiency involving careful analysis of the current position, exploration of potential improvements in services both within HHS and from service providers, horizon scanning of new treatments and technologies and implementation of agreed changes.

In addition the MSK Clinical Lead will manage a caseload, providing proactive case management services for complex MSK claims in liaison with members of the healthcare team, the patient, and the client where appropriate. The MSK Clinical Lead will ensure that all parties have the relevant information and the member receives appropriate medical information and access to required medical services within the terms of their plan/policy, while incorporating NHS navigation options and cost-containment measures as standard.  

The MSK Clinical Lead will work closely with our MSK providers to achieve the outcomes outlined above. In addition, the MSK Clinical Lead will be required to meet with clients on occasion to provide analysis of their MSK requirements and advice and support to implement services appropriately, as well as providing ad hoc and formal clinical support to all other departments in the business including the non-clinical operational team, Support Services and the Account Management team.

Key activities/main duties:

MSK Pathway

  • Continue to develop our HHS MSK strategy and clinical pathways for surgical and non- surgical management of all MSK claims
  • Explore, review and implement emerging technology where there is a sound evidence base


  • Lead in service developments through review, audit and evaluation of outcome measures
  • Recommend and lead changes/improvements to the service as required
  • Work with other professionals in managing operational issues of services which cross organisational boundaries
  • Participate and contribute to a range of meetings and forums as required


  • Liaise and work with other clinicians and colleagues (internally and externally) to make accurate assessments based on the information provided  to manage cases efficiently and ensure the very best care plan is established for members
  • Provide clinical guidance and support to the non-clinical teams to ensure members receive timely and accurate cover decisions, allowing them to progress with their treatment
  • 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
  • Undertake other business activities and tasks as required ensuring ongoing operational effectiveness, efficiency and positive contribution to Healix Group, including data gathering for reporting purposes and clinical input for relevant IT updates
  • Maintain up to date knowledge of clinical practice and use this to ensure the department acts in accordance with best clinical practice and appropriate methods of healthcare delivery
  • Develop policies and guidelines related  to MSK service delivery
  • Maintain and develop clinical governance polices
  • Undertake clinical training with other team members as required
  • Maintain CPD through appropriate education and training

Case Management

  • Maintain own caseload, ensuring a proactive case management approach through regular communication with the member, specialist and client (if appropriate)
  • Use the Case Management System (CMS) for all aspects of case management
  • Arrange care with an appropriate medical team / medical facility, utilising a directional approach to ensure quality and cost effectiveness of treatment
  • Ensure that treatment delivered is appropriate at all times by monitoring ongoing treatment plans for individuals
  • Monitoring treatment progress and liaise with the provider to ensure the member is discharged to an appropriate environment and in a timely manner
  • Pro-actively case manage by anticipating treatment pathways and likely costs in advance of treatment


  • Responsible for the provision of an efficient, cost effective and clinically appropriate MSK service to Health Services clients
  • Answer calls and emails from members in relation to medical claims or enquiries
  • Gather accurate and salient facts in a timely manner without exploring unnecessary avenues
  • Assess eligibility of treatment within the plan/policy terms and conditions, ensuring correct processes are followed for declines, shortfalls and complaints (including in accordance with FCA regulations where appropriate)
  • Provide statistics as required in relation to own caseload
  • Maintain accurate case records on the CMS system to include details of care delivered and all related communication
  • Communicate effectively with all parties providing relevant information to:
    • Internal stakeholders and other Healix Health Services departments
    • Members and their families
    • Providers and treating medical team
    • Clients and, where appropriate, underwriters
  • Ensure that costs remain routine and customary for the care delivered
  • Audit provider invoices where necessary using clinical knowledge
  • Provide feedback on protocols and working practices to colleagues and the management team
  • Develop or assist with the development of standard operating procedures and protocols
  • Operational management of network providers and the development of preferred MSK providers including physiotherapy clinics,  treatment centres (hospitals) and specialists


How to apply

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