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Community Transfer of Care Hub Case Manager
2 months ago
We are seeking a highly skilled and experienced professional to join our team as a Community Transfer of Care Hub Case Manager. This is an exciting opportunity to work in a dynamic and innovative environment, where you will play a key role in supporting patients to return to their own homes following acute illness or injury.
Key Responsibilities- Provide person-centred, holistic assessments to facilitate discharge from acute hospitals to the right discharge pathway.
- Triage referrals received by the Transfer of Care Hub, liaising with patients, family/carers, and ward staff to identify the most appropriate discharge pathway.
- Support the Transfer of Care Hub to discuss complex cases with all partners to agree a joint action and discharge plan.
- Utilise multi-disciplinary assessment skills, supported by sound clinical reasoning, to facilitate timely hospital discharge to the most appropriate environment.
- Effectively triage and prioritise a large caseload, adjusting daily work plans in response to system-wide pressures and escalation.
- High-level problem-solving required, gathering information from a range of sources, using professional experience and clinical knowledge to inform decision making.
Sirona care & health CIC is a leading provider of adult and children's community services in England. We are committed to delivering high-quality care and support to our patients, and we are seeking a dedicated and passionate individual to join our team.
Requirements- Professional qualification in nursing, occupational therapy, or physiotherapy, registered with NMC, HCPC, or RCN.
- Able to work across professional and organisational boundaries, recognising barriers to partnership working and implementing solutions.
- The ability to interpret clinical information, use analytical and problem-solving skills to inform decision making.
- Able to demonstrate innovative practice and coordinate/manage a caseload, prioritising workload, using escalation plans, time management, and delegation.
- Ability to present information to the CCG to support the requirement of additional funding to enable hospital discharge.
- Ability to complete mental capacity assessments and make best interest decisions as part of a multi-disciplinary team.
