Senior Clinical Case Reviewer/assessor, Nhs Chc

7 months ago

Preston, United Kingdom NHS Lancashire and South Cumbria Integrated Care Board Full time

The post holder will have a lead and managerial role with respect to NHS Continuing Healthcare (CHC) appeals and retrospective reviews. The role will involve scrutinising and analysing the appropriate health and social care information, meeting with representatives to attempt to resolve the dispute locally, considering and examining representative comments and helping to prepare final reports. The post holder will have line manager responsibilities and take a leading role in relation to NHS England’s Independent Review Panel hearings.
- Provide clinical expertise for CHC Appeals, and retrospective reviews.
- Ensure the National Framework and local processes have 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.
- Line manage and support clinicians and administrators working in the appeal/retrospective team
- Work to timescales in line with National Framework guidance in respect of CHC disputes and previously unassessed periods of care assessments.
- 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.
- Provide timely relevant correspondence to patients/families/representatives ensuring they are kept informed of developments
- Ensure 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
- Provide 1:1 support, supervision, development reviews and appraisals to band 6 clinicians and administration staff.
- Adhere to and uphold the ICB’s vision and values
- Observe the provisions of and adhere to all ICB policies and procedures
- Complete ICB Statutory and Mandatory training as required and any other training courses relevant to the post
- Abide by the ICB’s commitment that all staff will be treated with respect by management, colleagues, patients and visitors and equally staff will treat management, colleagues, patients and visitors with the same level of respect. Staff will be supported to challenge any discriminatory behaviour that may be based on differences in race, disability, language, culture, religion, sexuality, age, and gender or employment status.
- Adhere to relevant Code of Practice of Professional body (if appropriate)

The post holder must be flexible in the duties performed and it is expected that similar duties, not specifically listed above, will be carried out as required and may be cross site.

Experience
- Previous experience of working in a clinical role, with a thorough knowledge of clinical settings and pathways

**Qualifications**:

- Nursing qualification or equivalent HCP, Occupational Health, Physiotherapy etc

Skills, Knowledge & Competencies
- Experience in communications and stakeholder managementA good understanding of the health and social care environment and roles and responsibilities within itExperience of chairing/leading meetings, particularly of a complex and sensitive nature

Communication Skills
- 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
- Strong communication, networking and engagement skills suitable for effective working with patients, families, other health professionals and external stakeholders

Analytical
- Ability to analyse and interpret information, pre-empt and evaluate issues and recommend appropriate course of action to address the issue
- Independent thinker with demonstrated good judgement, problem solving and analytical skills

Management Skills
- Takes decisions on difficult and contentious issues where there may be a number of courses of actionAbility to use initiatives to decide relevant actions and make recommendations to Line Manager with the aim to improving deliverables and compliance to policiesAbility to engender trust and confidence and demonstrate integrity in the provision of advice and support

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