Care Coordinator

3 weeks ago


Cambridge, United Kingdom Bottisham Medical Practice Full time

**Job description Duties and Responsibilities**: Patient liaison & support, working with the wider MDT Support patients to utilise decision aids Identify patient care and support needs working together to meet these within a single personalised care and support plan Answering queries from patients, making appointments, and ensuring good quality written or verbal information to help them make choices about their care and assist them to use available tools to understand their own health Along with our social prescriber team, assist people to access self-management education courses, peer support or interventions that support them to take more control of their health and wellbeing and ensure appropriate patients are accessing training, education and financial benefits where eligible Explore and assist people to access personal health budgets where appropriate Provide coordination and navigation for people and their carers across health and care services, working closely with social prescribing link workers, health and wellbeing coaches, and other primary care professionals Support the coordination and delivery of MDTs within the PCN Implement new pathways for effective follow up of patients with long term conditions Patient Records, Coding and Data Quality Generate recall reports for QOF and contact patients to arrange recalls for chronic diseases, ensuring timely reviews for patients with health professionals Work within the QOF team, attend QOF meetings and notify clinicians of QOF targets and work to be achieved Review QOF and IIF criteria ensuring data entry and clinical coding is correct Run requests searches and data collection for data quality reviews, audits and research activity Invite patients for NHS Health Checks and Learning Disability Health Checks, reviewing and updating processes, letters and forms as appropriate Utilise population health intelligence (via our NHS software, ARDENs and Eclipse and Systm1) to proactively identify and work with a cohort of patients to deliver personalised care Assist in the resolution of registration queries Review the patient registration list, sending out of area letters to ensure patients are only registered who live within the practice boundary limits, supporting patients during this process Alongside the Dispensary Manager, streamline and maintain online proxy access facilities for each of the care homes Process clinical cervical screening reports and recalls, updating cervical smear results Enter mammogram results and correct codes Monthly corticosteroid report, adding relevant codes and sending letters once checked by clinician Process diabetic eye screening reports IT and Communications: Update the practice website


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