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Job summary

Main area
NHS Continuing Healthcare and Individual Commissioning
Grade
NHS AfC: Band 6
Contract
Permanent
Hours
Part time - 19.5 hours per week (Monday to Friday - 9am to 5pm negotiable)
Job ref
942-ICB-6468022
Employer
NHS Shropshire, Telford and Wrekin Integrated Care Board
Employer type
NHS
Site
Wellington Civic Offices
Town
Wellington
Salary
£33,706 - £40,588 pa pro rata
Salary period
Yearly
Closing
28/07/2024 23:59

Employer heading

NHS Shropshire, Telford and Wrekin Integrated Care Board logo

Appeals and Retrospective Assessor

NHS AfC: Band 6

Job overview

Following a workforce and operating model redesign an exciting opportunity has arisen for an Appeals and Retrospective Assessor. The Individual Commissioning Team is responsible for assessment, commissioning and case management for individuals with complex health needs, including NHS Continuing Healthcare, NHS Funded Nursing Care, Mental Health Act and subsequent aftercare, hospital discharge and end of life care. All roles within the team offer opportunity to make a positive difference to the lives and experiences of those who access our services.

You will be joining the team at a time where processes are being redesigned to ensure they provide an holistic approach to meeting the healthcare needs of the individuals we support. You will manage the co-ordination and assessment of a range of patients assigned to them, including formal eligibility assessments and co-ordination of the appeals and retrospectives process.

You will have full understanding of the National Framework for NHS Continuing Healthcare and Funded Nursing Care, Who Pays guidance and relevant sections of the Mental Health Act and commissioning and contracting principles. You must also possess a current NMC or HCPC professional registration.

The role will support the Associate Director and Service Manager with ensuring that statutory responsibilities are met and for ensuring senior oversight of the team and functions.

Main duties of the job

Job Summary

  • The postholder will the manage the co-ordination and assessment of a range of patients assigned to them, including formal eligibility assessments and co-ordination of the appeals and retrospectives process.
  • The postholder will have a flexible approach to care and will work across inter-agency boundaries, maintaining good communication and liaison skills with all professionals and members of the publi
  • The postholder will lead the appeals and retrospectives process.

Working for our organisation

The NHS is the biggest employer in Europe. It’s a world-renowned institution and an exciting place to work, full of challenges and opportunities.

NHS Shropshire, Telford and Wrekin was created on 1 July 2022 and is responsible for planning and buying a wide range of health and care services for the whole of Shropshire, Telford and Wrekin. These include GP and primary care services, hospital care, community healthcare and mental health services. We also have a duty to monitor these services to ensure they provide a high level of care and are value for money. We are clinically-led and work closely with the 51 GP practices across the county. This means we can have closer links to our patients so we can develop more personalised local health services.

In return, we provide a supportive environment in which to learn and develop, with the opportunity to further your skills and career within an exciting and evolving environment. Joining our inclusive and innovative team comes with a range of benefits including flexible & agile working arrangements, pension scheme and generous annual leave allowance. With our training schemes and support networks, you will be empowered to play a leading role in the future of healthcare, whatever your specialism or interest. And as a member of NHS staff you will receive plenty of discounts too.

Detailed job description and main responsibilities

Communication & Relationships Skills

  • To provide relevant and timely specialist advice and guidance on functional and information matters.
  • To support the development of internal and external communications where required by regular contact with the teams, stakeholders and Communications team.
  • To be  responsible  for  preparation  of  correspondence  and complex  report, assessments and papers.
  • To undertake complex clinical assessment and clinical report writing.
  • To represent the team on panels and decision making forums  as   required,  participating   in   the   decision-making   process   and   clarification   of   funding responsibilities for clients who are registered with a NHS Shropshire, Telford and Wrekin GP.
  • To represent NHS Shropshire, Telford and Wrekin on all appeals panels, including Local Resolution Panels (LRP) and Independent Review Panels (IRP) including NHSE appeal panels.
  • To work with team members and other health and social care professionals to promote joint working to achieve positive benefits and added value for individual service users and carers.
  • To liaise and communicate with external agencies including; NHS England, care providers, solicitors, advocates and the Ombudsman.
  • To maintain constructive relationships with a broad range of internal and external stakeholders.
  • To participate in relevant internal and external working groups/projects, services, and initiatives which may be highly complex, sensitive, political, and contain contentious information with the aim of providing information and analytical advice to the teams.
  • To communicate complex, clinical, personal and emotive information about patients and circumstances including risks, issues and dependencies, diagnosis, prognosis and eligibility to NHS funded services.
  • To lead on the management of contentious cases which are highly complex and sensitive, acting as representative in legal proceedings.
  • To deal with regular telephone calls throughout the day, addressing highly sensitive and complex enquiries, issues of concern regarding patient wellbeing, complaints and referrals that may require an immediate response
  • To participate in the monitoring, review and complaints procedures of individuals with complex needs whose care is managed in their own homes or in residential care settings.

Analytical & Judgement Skills

  • To undertake complex and detailed analysis of specific projects and patients requiring high levels of concentration.
  • To update, maintain, organise, gather and analyse information to predict/meet future individual patient, organisational and team needs by identifying best professional practice.
  • To contribute to the information management of performance, taking a lead for specific projects
  • To provide co-ordination of and participate in relevant meetings, reporting attendance and providing information advice and support where requested

Planning & Organisational Skills

  • To plan own workload and diary to ensure local, national and statutory targets and deadlines are met.
  • To undertake complex clinical assessment and care planning to ensure patient need is met and that where appropriate, step-down/discharge is planned and co-ordinated to ensure patient need is met in the least restrictive way.
  • To work with members of the team and key stakeholders to investigate the causes of any variance from plan/delivery targets and contribute to the implementation of solutions.

Patient/Client Care

  • To manage a defined caseload undertaking responsibilities as delegated by the Team Leader/Manager - this will include the routine management of complex cases and the planning, organising and commissioning of specialised care packages ensuring the maintenance of accurate records.
  • To participate in the assessment, monitoring, review and complaints procedures of individuals with varying levels of complex needs whose care is managed in their own homes or in care settings.
  • To assist or lead (depending on who is the responsible commissioner) in the co-ordination of complex decisions involving members of the multi-disciplinary / multi-professional team as required.
  • To assist in the collaboration and the co-ordination of the review and assessment process and to undertake reviews and assessments, including formal eligibility assessments as indicated.
  • To undertake needs portrayal and retrospective assessments for PUPOC and appeals.
  • To practise at all times in a manner that is within the NMC Code of Conduct and Guidelines or equivalent for specialist health profession.
  • To practice at all times within a clinical governance framework that promotes quality.
  • To co-ordinate and commission complex care packages involving members of the multi-disciplinary/multi-professional team

Policy/Service Development

  • To contribute to the strategic planning recommending adjustments, as necessary.
  • To support implementation of strategic modernisation/service improvement, public health, workforce or commissioning strategies and any associated action plans, in accordance with the agreed priorities of the team.
  • To contribute to the development of performance and governance strategies and the development and implementation of improvement programmes.
  • To deliver against objectives, achieving quality outcomes, prioritising own workload and working to tight deadline
  • To propose changes to own function, informing policy and making recommendations for other projects delivery.

Financial & Physical Resources

  • To support and inform teams on the targeting of resources, monitoring, implementing, evaluating and delivery of plans by providing sophisticated, high quality information and analysis.
  • To continually strive for delivering project/function/patient outcomes, value for money and greater efficiencies.
  • To contribute to the financial delivery of the service ensuring it is cost effective and delivered on time.

Human Resources/Staff Management

  • To provide specialist training, advice and support on own role/responsibilities across NHS Shropshire, Telford and Wrekin and the wider system.
  • To participate in the recruitment process of support staff.
  • To be accountable for own professional development and to participate in performance review.
  • To attend relevant training and staff meetings as required including participation in nursing and clinical development across NHS Shropshire, Telford and Wrekin.
  • To commit to undertake clinical supervision.
  • To matrix manage the appeals and retrospective process, including the monitoring of quality and deadlines for peer reviews.

Information Resources

  • To contribute  to  the  review  and  development  of  existing  information  management  systems  and contribute to the development of an integrated approach.
  • To maintain accurate and comprehensive clinical records.
  • To participate in and undertake audits and support the implementation of recommended action
  • To update, maintain, organise, gather and analyse information to predict/meet future organisational and team needs by identifying best professional practice.
  • To carry out timely and accurate information analysis and reporting on agreed areas of portfolio
  • To actively support and contribute to the development of key performance indicators for the successful assessment of performance.

Research & Development

  • To be accountable for own professional development and to participate in performance review.

 Freedom to Act

  • To independently make eligibility recommendations using professional judgement which is fully supported by clinical evidence and rationale.
  • To manage their own caseload independently whilst complying with all relevant clinical and commissioning process and policy.

Person specification

Essential

Essential criteria
  • Significant experience of working in a clinical field.
  • Clear communicator with excellent writing, report writing and presentation skills; capable of constructing and delivering clear ideas and concepts concisely and accurately for diverse audiences
  • Ability to analyse and interpret information, pre-empt and evaluate issues, and recommend and appropriate course of action to address the issues
  • Takes decisions on difficult and contentious issues where they may be a number of courses of action.
  • Ability to work on own initiative and organise own workload without supervision working to tight and often changing timescale
  • Demonstrate a strong desire to improve performance and make a difference by focusing on goals
  • Experience of assessment and commissioning (writing care plans etc)
Desirable criteria
  • A good understanding of the health and social care environment and roles and responsibilities within this
  • Previous experience in a similar role in public sector.

Experience & Knowledge

Essential criteria
  • CHC Experience / Knowledge

Qualifications

Essential criteria
  • Registered with the NMC (or equivalent specialist health profession) according to competency.

Employer certification / accreditation badges

Apprenticeships logoDisability confident employer

Applicant requirements

You must have appropriate UK professional registration.

This post is subject to the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (Amendment) (England and Wales) Order 2020 and it will be necessary for a submission for Disclosure to be made to the Disclosure and Barring Service.

Documents to download

Apply online now

Further details / informal visits contact

Name
Wendy Richardson
Job title
Assessment Team Manager
Email address
[email protected]
Telephone number
01952 580349
Additional information

Emily Jones

Assessment Team Leader

Email: [email protected]

Telephone: 01952 580349

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