Care Co-ordinator

8 months ago


Southampton, United Kingdom Walnut Tree Surgery Full time

For those patients who needs we are not able to meet through the routine navigation process, to support them through the receptions care navigation process. To ensure timely, efficient, and patient centred care planning for patients and their needs. To review patients needs and help to connect them to the services and support they require, whether within the practice or elsewhere. Initiate contact with and respond to requests from patients, team members and external agencies.

Work with individuals in a case management function to develop, implement and review their wellbeing care plan. To assess the needs of individuals identifying outcomes and determining the type of support required to overcome barriers and achieve outcomes. To undertake, review and amend risk assessments in relation to activities, clients and the environment. Working with the social prescriber, signpost to existing community groups within the delivery and wider network, which will support the individual in their achievement of wellbeing goals Support in regular case conferences with partner organisations, support services and/or other team members to ensure a client journey is smooth and consistent.

Undertake follow up contact to identify whether a patient has maintained their level of well-being and identify any risk to achieving this. Be fully responsible for all tasks related to journey / case management function including maintaining effective and efficient administrative procedures producing appropriate records and reports, including the updating of client details on the clinical system. Capture management information from delivery and wider network and provide reports accordingly. Coordinating clinics, booking appointments, dealing with admin, collating data and reports and providing feedback to the practice.

Direct access for other health professionals to update/or make requests for the most venerable patients Coordinating Ardens Manager uploads to assist whole PCN To liaise with palliative care and District Nursing teams to support patients care needs


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