Clinical Case Reviewer/Assessor, NHS CHC Appeals Team

Job description

Job responsibilities

• Provide clinical expertise for CHC Appeals, and retrospective reviews;
• Ensure the National Framework process has been robustly applied within the dispute and retrospective review process, with evidence to support CHC eligibility recommendations and decision making;
• Co-ordinate and Chair both local resolution and retrospective claim meetings and provide the expert clinical CHC advice at the meetings where patients/families have disputed decisions or requested back dated reviews of eligibility;
• Attend regular clinical supervision with Line manager.
• Bring to the attention of Line manager any issues in regard to the activity and volume of assessment requests in order to safely manage workload;
• Work to timescales in line with National Framework guidance in respect of CHC disputes;
• Support Line manager in representing Lancashire and South Cumbria Integrated Care Board (ICB) at local and regional meetings about CHC appeals or retrospective claims;
• Attend with Line manager to present and defend CHC cases at NHS England's 'Independent Review Panels' on behalf of the ICB
• Support Line Manager to review CHC appeals and retrospective review processes to identify any opportunities to improve pathways as appropriate to enhance quality and effectiveness;
• Meet with patients/representatives in potentially highly contentious situations and provide responses to complex CHC disputes.
• Be expected to engage with patients and public in a meaningful way in relation to CHC appeals and retrospective reviews.
• Ensure patient/families/representatives are supported and aware of the appeal process followed by the ICB in relation to CHC
• Provide timely relevant correspondence to patients/families/representatives ensuring they are kept informed of developments.
• Work in partnership with the Finance Department to ensure any payment is calculated, interest is applied (if appropriate) and processed in line with ICB policies.
• Support Line Manager in ensuring the relevant documentation. including Health and Social care records are provided in a timely manner to NHS England as part of the independent review panel appeal process.
• Attend Personal Development Review as requested by Line manage.

Person Specification

Experience

Essential

• Educated to degree level in relevant subject or equivalent level of experience of working at a similar level in a specialist area

Knowledge

Essential

• A good understanding of the health and social care environment and roles and responsibilities within it

Analytical skills

Essential

• Ability to analyse and interpret information, pre-empt and evaluate issues and recommend appropriate course of action to address the issue

Management skills

Essential

• Ability to engender trust and confidence and demonstrate integrity in the provision of advice and support

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).

Employer details

Employer name

NHS Lancashire and South Cumbria Integrated Care Board (125)

Address

County Hall

Fishergate Hill

Preston

PR1 8XB

Employer's website

https://www.lancashireandsouthcumbria.icb.nhs.uk/ (Opens in a new tab)