Sirona care & health CIC

Community Transfer of Care Hub Case Manager

This job is now closed

Job summary

Are you a Nurse or Therapist looking for a community job in a developing service?

Are you passionate about supporting people to return to their own homes following acute illness or injury?

This could be the role for you!

The aim is to work collaboratively and holistically to support patients to get 'Home First' by co-locating a team of professionals from different organisations to streamline complex discharges. To have face to face conversations that facilitate partners working together to maximise opportunities for an early discharge that embraces positive risk taking and keeps the patient at the centre of everything that we do.

The successful candidate will be a key member of the multi-disciplinary team, responsible for providing person-centred, holistic assessment to facilitate discharge from the acute hospitals to the right discharge pathway.

You will need to have experience working in the community setting and an understanding of the levels of clinical acuity that can be supported in peoples own homes. Alongside this you will have an understanding of rehabilitation pathways, discharge planning and mental capacity issues, excellent interpersonal and negotiation skills.

In return, we will provide you with regular training and supervision and enable you to become involved in future service developments.

Main duties of the job

UHBW have two Transfer of Care Hubs to support our patients with discharge planning from admission through leaving hospital and into the community: one Hub at the Bristol Royal Infirmary and one at Weston General Hospital.

You will be a key member of the multi-disciplinary team, responsible for providing person-centred, holistic assessment to facilitate discharge from the acute hospitals to the right discharge pathway.

You will be responsible for triaging referrals received by CToCH. This may include liaising with the patient, family/carers and ward staff to identify the most appropriate discharge pathway.

Part of your role is to support the CToCH to discuss complex cases with all partners in the Transfer of Care Hub to agree a joint action and discharge plan.

You will utilise multi-disciplinary assessment skills, supported by sound clinical reasoning to facilitate timely hospital discharge to the most appropriate environment

You will effectively triage and prioritise a large caseload and be able to adjust daily work plan in response to system-wide pressures and escalation. Pro-actively optimising the usage of community capacity on a daily basis.

There is a high level of problem-solving required, using professional experience and clinical knowledge to inform decision making. This includes being able to complete mental capacity assessments and make best interest decisions where appropriate.

About us

We are Sirona care & health, a Community Interest Company committed to providing local communities with a range of high-quality specialist healthcare services across Bristol, North Somerset and South Gloucestershire. For us, it's about the personal approach; we take pride in what we do and deliver the high standard of care we would expect for ourselves and our families.

At Sirona, we continue to build an inclusive culture that encourages, supports, and celebrates the diverse voices of colleagues, people and communities. We welcome applications from all who feel they have the skills and attributes to make a real difference.

Benefits:

We offer NHS Agenda for Change Salary, Terms and Conditions and the NHS pension scheme plus much more!Please see the benefits leaflet attached to this advert for details.

We offer NHS Agenda for Change (AfC) salary including annual leave supplement, Stakeholder pension, a range of health and wellbeing incentives, high street discounts, plus much more!

Date posted

31 May 2024

Pay scheme

Agenda for change

Band

Band 6

Salary

£35,392 to £42,618 a year per annum

Contract

Permanent

Working pattern

Full-time, Flexible working

Reference number

083-6300071-MP

Job locations

South Bristol Community Hospital

Hengrove Promenade

Hengrove

BS14 0DE

Job description

Job responsibilities

Please see the attached Job Description for a full list of duties and responsibilities before applying for this position.

We are unable to provide sponsorship for this role and can only accept applications from UK based applicants.

Job description

Job responsibilities

Please see the attached Job Description for a full list of duties and responsibilities before applying for this position.

We are unable to provide sponsorship for this role and can only accept applications from UK based applicants.

Person Specification

Qualifications

Essential

Professional Qualification in Nursing, Occupational Therapy or Physiotherapy. HCPC, RCN or NMC

Skills, knowledge and experience

Essential

Able to work across professional and organisational boundaries - recognising when there are barriers to partnership working and able to implement solutions to overcome these
The ability to interpret clinical information, use analytical and problem-solving skills to inform decision making
Able to demonstrate innovative practice
Ability to coordinate and manage a caseload including prioritising the workload, appropriate use of escalation plan, time management and delegation
When required to be able to present information to the CCG to support the requirement of additional funding (e.g., 1-1 support) to enable a hospital discharge
Ability to complete mental capacity assessments when required and if the patient lacks capacity act as the lead for making a best interest decision as part of a multi-disciplinary team
A competent level of IT skills including user knowledge of core Microsoft Office packages and electronic patient records

Desirable

Experience of working within hospital and community settings

Person Specification

Qualifications

Essential

Professional Qualification in Nursing, Occupational Therapy or Physiotherapy. HCPC, RCN or NMC

Skills, knowledge and experience

Essential

Able to work across professional and organisational boundaries - recognising when there are barriers to partnership working and able to implement solutions to overcome these
The ability to interpret clinical information, use analytical and problem-solving skills to inform decision making
Able to demonstrate innovative practice
Ability to coordinate and manage a caseload including prioritising the workload, appropriate use of escalation plan, time management and delegation
When required to be able to present information to the CCG to support the requirement of additional funding (e.g., 1-1 support) to enable a hospital discharge
Ability to complete mental capacity assessments when required and if the patient lacks capacity act as the lead for making a best interest decision as part of a multi-disciplinary team
A competent level of IT skills including user knowledge of core Microsoft Office packages and electronic patient records

Desirable

Experience of working within hospital and community settings

Disclosure and Barring Service Check

This post is subject to the Rehabilitation of Offenders Act (Exceptions Order) 1975 and as such it will be necessary for a submission for Disclosure to be made to the Disclosure and Barring Service (formerly known as CRB) to check for any previous criminal convictions.

UK Registration

Applicants must have current UK professional registration. For further information please see NHS Careers website (opens in a new window).

Additional information

Disclosure and Barring Service Check

UK Registration

Applicants must have current UK professional registration. For further information please see NHS Careers website (opens in a new window).

Employer details

Employer name

Sirona care & health CIC

Address

South Bristol Community Hospital

Hengrove Promenade

Hengrove

BS14 0DE

Employer's website

https://www.sirona-cic.org.uk/ (Opens in a new tab)

Employer details

Employer name

Sirona care & health CIC

Address

South Bristol Community Hospital

Hengrove Promenade

Hengrove

BS14 0DE

Employer's website

https://www.sirona-cic.org.uk/ (Opens in a new tab)