Q&A with our Medical Case Manager, Tanya Spicer-Phillips

My inspiration to become a nurse stemmed from a deep desire to make a meaningful difference in people’s lives by supporting their health and well-being. Nursing offers a unique blend of direct patient care, be this over the phone or in person, with critical thinking and advocacy, which resonate with my passion for helping others navigate complex health challenges.

In my role as a case manager, this base in nursing allows me to understand the medical needs of patients more thoroughly as I am regularly researching conditions, treatments, and outcomes, which allow me to advocate effectively for the cover and care they require. This can help members achieve the best possible outcomes through coordinated care with other clinical team members and providers and informs decision-making.

A clinically led healthcare scheme is valuable for the members I case manage because it ensures that decisions about care and coverage are guided by healthcare professionals with direct clinical expertise. This clinical element brings an understanding of medical conditions, treatment options and patient needs, which helps to manage and understand the health plans set for them, to know that they are both effective and patient-centred. 

Ultimately, a clinically led scheme promotes better quality of care, enhances member satisfaction and helps manage costs by focussing on appropriate and timely interventions. This includes giving guidance to the non-clinical team members at Healix in relation to all members needs.

I support members throughout their healthcare journey by being there for them at every step if needed. I understand that navigating health challenges can be overwhelming, so I make it my priority to listen carefully to their concerns and provide clear, compassionate guidance and assistance, tailored to their situation where possible. 

I can help members understand their benefits and connect them to services. When obstacles come up, I’m there to advocate for them and find solutions. My goal is not just to manage their care pathways, but build trust and offer reassurance, so members feel supported. 

This makes the role truly meaningful to me.

My role revolves around supporting members and their healthcare needs in a hands-on, problem-solving way. I start by reviewing the cases to understand each member’s needs and any challenges. I connect with other healthcare providers to coordinate care plans and make sure these are aligned with the insurance coverage. I regularly communicate with members, providing updates, offering guidance. I also manage the authorisations in line with NHS guidance and any scheme limitations. 

The role requires empathy, attention to detail and collaboration. The role also involves invoice interpretation and management, cost containment, future planning in terms of understanding and communicating likely future health pathways and the costs related to these and continuous collaboration with the wider team and non-clinical teams.

I ensure every member feels supported and understood by taking the time to listen carefully to their individual needs and concerns and experiences. Every person’s healthcare journey is unique, so I try to acknowledge their feelings and needs without rushing the conversation. 

I communicate in clear language to avoid any confusion or ambiguity and encourage members to ask questions. I regularly update members when they are awaiting cover decisions and let the member know they can reach out to me directly with any questions or needs they may have.