Pcn Care Coordinator

3 months ago

Nottingham, United Kingdom Synergy Health Primary Care Network Full time

**Role Objectives**: The post holder, working closely with the PCN team, GPs and existing community services will: Coordinate Multi-Disciplinary Team meetings for people living in the community Utilise Population Health Intelligence to proactively identify patients at risk and work with the PCN team to enable the PCN team to deliver personalised care Utilise Population Health Intelligence tools where needed to support other patients in the PCN. Support the achievement of the IIF targets through reporting and communication Be responsible for daily updating of patients on e-HealthScope Workflow to identify patient to support the PCN team with identifying community pathways that might prevent hospital admission and for identifying potential gaps in care Be responsible for arranging, attending and minuting Multi-Disciplinary Team Meetings Proactively prepare any actions prior to the MDT meetings ensuring all relevant clinicians are present To record patient interventions on relevant electronic database systems (e.g. SystmOne) and contribute to report generation, analysis and production Follow up on all forward actions resulting from MDT discussions Be responsible for logging and making referrals To contribute to the integration of health and social care by maintaining up to date recording systems for all agencies within the PCN Team and providing information to any member of the PCN Team in order to ease processes and communication in agreement with data protection protocol To be responsible for recording, reporting and producing evaluation reports which will include evaluation detailing effectiveness outcomes of new roles. To be customer (patient, carer, GP) focused when representing the service To work collaboratively with other teams and services to maintain an effective and efficient service To offer appropriate support and guidance to patients and their families/carers To plan / organise work using own initiative, whilst being able to work as a valuable member of a team To have excellent IT skills, to include Microsoft Office, Outlook and Excel To undertake general office duties to support the role To work effectively as part of a team to provide cover for Care Coordination Teams when required and to be flexible regarding working hours to meet the needs of the service To ensure all electronic records are updated and complete within the agreed time-scales To use a range of verbal and non-verbal communication tools to communicate effectively with patients, carers and families and colleagues.

All employees have a responsibility to support the organisation in our duties by: Attending mandatory training on Safeguarding children and adults. Making sure they are familiar with their and the organisations requirements under relevant legislation. Adhering to all relevant national and local policies, procedures, practice guidance (e.g. LSCB Child Protection Procedures and Practice Guidance) and professional codes.

Reporting any concerns to the appropriate authority. Equality and Diversity The organisation is committed to promoting equal opportunities to achieve equity of access, experience and outcomes and to recognising and valuing peoples differences. This applies to all activities as a service provider, as an employer and as a commissioner. Information Management and Technology (IM&T) All staff are expected to utilise the relevant national and local IM&T systems necessary to undertake their role.

Flexible Working The organisation is committed to offering flexible, modern employment practices, which recognise that all staff need to strike a sensible balance between home and work life. All requests to work flexibly will be considered. Resource Management Ensure the effective and efficient use of physical and financial resources, make recommendations regarding supplies and equipment Freedom to Act Adhere to organisations policies and procedures, guided by occupational policies and procedures in primary and secondary care. Maintain up to date skills and knowledge and maintain awareness of professional issues.

The job holder will carry out any other duties as may reasonably be required by their line manager. The job description and person specification may be reviewed on an on-going basis in accordance with the changing needs of the PCN and the Organisation. Physical and Mental Skills The post holder should be physically fit for the role with the necessary keyboard and IT skills. Required to communicate across the health community and with patients / carers where the nature of the information given may be sensitive and could be disputed.

The post holder should be empathetic and skilled in listening, persuasion and negotiation, and recognises Care, Compassion, Courage, Competency, Communication, and Commitment in their role. Effort and Environment Physical effort: Frequent long periods of time spent writing up patient related information within agreed time limits. There is a need for speed and accuracy. This is a c

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