South West London Integrated Care Board

Appeals / Retros Clinical Manager-A

This job is now closed

Job summary

This role will case manage all the appeals and retrospective assessments for the CHC service across SWL. This will include liaising with key individuals, the client and their representative to ensure the National Framework for CHC was adhered to initially and the appeals process is followed accordingly through the stages. Where appropriate, you will represent the SWL ICB at Independent Review Panels, ensuring that any learning from this is shared with the wider SWL ICB CHC teams.

Main duties of the job

Appeals / Retros Clinical Manager

The post holder will be responsible for a team delivering appeal and retrospective reviews of individual's eligibility for Continuing Healthcare and Funded Nursing Care. The post holder will ensure these are carried out in a timely manner according to national specifications.

The post holder will work with all stakeholders including clients and, where relevant, their families, to ensure that decisions are taken in a transparent and coherent manner.
The post holder will ensure that they keep accurate records and are able to demonstrate that funding recommendations are evidence based and made according to the criteria described within national CHC frameworks.

About us

NHS South West London Integrated Care Board (ICB), as part of South West London Integrated Care System (ICS), is a partnership of organisations that come together to plan and deliver joined up health and care services to improve the lives of people in our six boroughs: Croydon, Merton, Kingston, Richmond, Sutton and Wandsworth.

Each ICS consists of two statutory elements:

an Integrated Care Board, bringing the NHS together with its partners locally to improve health and care services
an Integrated Care Partnership (ICP): the broad alliance of organisations and representatives concerned with improving the care, health and wellbeing of the population, jointly convened by the ICB and local authorities in the area.

ICBs are statutory NHS bodies responsible for planning and allocating resources to meet the four core purposes of integrated care systems (ICSs):

to improve outcomes in population health and healthcare;
tackle inequalities in outcomes, experience and access;
enhance productivity and value for money and;
help the NHS support broader social and economic development.

NHS South West London Integrated Care Board decides how the South West London NHS budget is spent and develops plans to improve people's health, deliver higher quality care, and better value for money.

Date posted

02 October 2024

Pay scheme

Agenda for change

Band

Band 7

Salary

£51,883 to £58,544 a year Per Annum inclusive of Outer HCAS

Contract

Permanent

Working pattern

Full-time

Reference number

491-SWLCHC014-A

Job locations

SWL CHC (K&R) Team (930157) L4

120 The Broadway

London

SW19 1RH

Job description

Job responsibilities

Please refer to the Job Description for full details.

The post holder will be responsible for a team delivering appeal and retrospective reviews of individuals eligibility for Continuing Healthcare and Funded Nursing Care. The post holder will ensure these are carried out in a timely manner according to national specifications.

The post holder will work with all stakeholders including clients and, where relevant, their families, to ensure that decisions are taken in a transparent and coherent manner.

The post holder will ensure that they keep accurate records and are able to demonstrate that funding recommendations are evidence based and made according to the criteria described within national CHC frameworks.

The post holder will ensure that evidence used to undertake these assessments is up to date and supports the clients current care needs. Further to this, the individual will ensure that where a need for on-going referral to another specialist is required (e.g. DOLs, Safeguarding, SALT, OT, CHIT Community LD specialist Team), that this is completely promptly, with the outcome of any referrals being included in the appeal,

The post holder is to act as an advocate for the vulnerable, challenging poor practice and discriminatory attitudes and behaviour relating to their care. This will include both challenging the situation at the time, and also reporting it to an appropriate person or authority as necessary. This is not exclusive to the client being assessed.

Develop and monitor clinical/practice standards for the service and contribute to the annual audit plan for CHC and lead peer review and other quality and audit initiatives.

Support senior clinical management team in investigating complaints and ensure that learning from these is disseminated and assimilated by the CHC team, making changes to standard operating procedures as necessary.

Ensure the provision of consistently good quality assessments and reviews of both eligibility and care packages within their team.

Work with the appropriate quality and safeguarding leads to identify and manage concerns relating to patient safety and quality issues identified through team assessment or review.

Deliver, where appropriate, sensitive and confidential information to clients and families regarding diagnosis, prognosis and life altering situations/decisions and to offer ongoing support e.g. when it becomes necessary to provide an appropriate placement in a nursing/residential home.

The post holder will provide the Clinical Services Manager Adults CHC with information verbally or in writing, so s/he is fully always briefed on any team issues.

The post holder will have to communicate sensitive information effectively, at all levels, inside and outside the organisation. This may include: clients and families, staff, Team Leaders, Service Managers, Directors and ICBs.

The post holder will hold a clinical caseload in agreement with Clinical Lead for Appeals and Retrospectives.

Facilitate MDT assessments including nursing assessments, care planning, implementation and evaluation of care planning interventions for the most complex cases.

Use analytical and judgement skills in identifying and assessing complex facts and situations requiring interpretation and comparison of a range of options at MDT meetings and clinical panels.

The post holder will be professionally and legally accountable and responsible for own clinical work.

The post holder will demonstrate evidence based practice.

Job description

Job responsibilities

Please refer to the Job Description for full details.

The post holder will work with all stakeholders including clients and, where relevant, their families, to ensure that decisions are taken in a transparent and coherent manner.

The post holder will ensure that evidence used to undertake these assessments is up to date and supports the clients current care needs. Further to this, the individual will ensure that where a need for on-going referral to another specialist is required (e.g. DOLs, Safeguarding, SALT, OT, CHIT Community LD specialist Team), that this is completely promptly, with the outcome of any referrals being included in the appeal,