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Case Manager

1 month ago

Telford, United Kingdom NHS Shropshire, Telford and Wrekin Integrated Care Board Full time

Job summary

The case management team is responsible for the case management co-ordination for patients with learning disabilities, mental health, physical health and complex needs. Patient's needs are met and regularly reviewed in line with national requirements for patients eligible for NHS Continuing Healthcare (CHC), working within the Shropshire, Telford and Wrekin ICB. As a case manager, you will need to have a qualification as a registered nurse or social worker.

You must possess a current NMC or HCPC registration and have the ability to travel within the locality, with occasional requirement for travel out of county.

You will be expected to have an understanding of the National Framework for NHS Continuing Healthcare and Funded Nursing Care, in particular the elements in relation to patient reviews. Knowledge of the Mental Health Act, particularly s117 eligibility is desirable as is experience of the application of the Mental Capacity Act, Best Interest decision making, Deprivation of Liberty Safeguards (DOLS) and Court of Protection matters.

Ideally, you will be an experienced CHC assessor and commissioner, however, if you have experience of case management and do not have CHC experience we would still like to hear from you.

Main duties of the job

We are looking for a person with a background in patient assessment, experience in liaison with the multidisciplinary team and a knowledge of/or experience of care provision. You will observe and evaluate care needs and signpost and direct to inform the most appropriate care provision to meet those identified needs. As a case manager you will be able to make a positive difference to the lives of those you work with, monitoring quality and assurance and financial agreements to enable value for money for the NHS and the patient. You will have learning and development opportunities to develop clinical knowledge of complex care and conditions, key skills in communication and liaison with multiple professional services and provider services. You will have opportunity to attend National and local forum to positively contribute towards NHS change and development. You will develop key leadership, organisational skills and develop IT and digital skills utilising the care recording systems in place.

About us

NHS Shropshire, Telford and Wrekin was created on 1 July 2022 and is responsible for planning and buying a wide range of health and care services for the whole of Shropshire, Telford and Wrekin. These include GP and primary care services, hospital care, community healthcare and mental health services. We also have a duty to monitor these services to ensure they provide a high level of care and are value for money. We are clinically led and work closely with the 51 GP practices across the county. This means we can have closer links to our patients so we can develop more personalised local health services.

In return, we provide a supportive environment in which to learn and develop, with the opportunity to further your skills and career within an exciting and evolving environment. Joining our inclusive and innovative team comes with a range of benefits including flexible & agile working arrangements, pension scheme and generous annual leave allowance. With our training schemes and support networks, you will be empowered to play a leading role in the future of healthcare, whatever your specialism or interest. And as a member of NHS staff you will receive plenty of discounts too.

Job description

Job responsibilities

Job Summary

The postholder is accountable to the Head of All Age Continuing Care and Individual Commissioning and responsible to the Case Management Team Manager. The postholder will be supported by a Team Leader.

The postholder will be expected to work across the breadth of specialties according to their competency levels. For example, all of the team will be expected to cover Personal Health Budgets (PHB) or appeals, but only those competent to cover childrens or Learning Disabilities (LD) would be expected to do so.

The postholder will take an active role and work as an expert clinician in facilitating and/or providing professional support, commissioning and case management of patients eligible for NHS Continuing Care, NHS Funded Nursing Care, CYP Continuing Care, those in receipt of joint or integrated funding and patients subject to various sections of the Mental Health Act This will encompass patients with complex physical, mental health and learning disability needs.

The postholder will have case management responsibility for a group of assigned patients and be responsible for ensuring that their health and care needs are met and regularly reviewed in line with local and national requirements and undertake eligibility assessments as indicated.

The postholder will undertake formal and informal teaching and training as needed. The candidate will possess expert knowledge and understanding of the process and commissioning approval system related policy and procedures relevant to the role.

The postholder will provide representation to a variety of multidisciplinary team meetings and panels.

The postholder will support teams to ensure that the portfolio of tasks/projects are planned, managed and delivered effectively.

The postholder will support and inform the targeting of resources, monitoring, implementation and evaluation of the tasks/projects by providing high quality support including complex information and analysis, communications and stakeholder management

The postholder will ensure accurate and open communication and co-ordination with a range of organisations and individuals.

The postholder will be a key member of the team as well as supporting effective communication and stakeholder management, both internally and externally

The postholder will ensure PHBs are promoted and implemented for their case load.

The postholder will undertake all required clinical and commissioning activity for patients on their caseload including following the DOLS process and once implemented Liberty Protection Safeguards (LPS), including undertaking mental capacity assessments, Court of Protection requirements and all requirements under the LPS legislation.

Key Working Relationships

The post holder will need to build and maintain constructive working relationships with internal and external stakeholders, including but not limited to:

Individual Commissioning management team

Individual Commissioning team members

Safeguarding teams

Local Authority

Service users and relatives

Solicitors and other legal representatives

NHSE/I

Care providers from all sectors

NHS STW colleagues

Educational establishments

Finance team

Commissioning team

Matrix work across all other teams to address interdependencies and ensure alignment of mutual objectives.

External consultancy, as required (this list is not exhaustive).

Key Duties & Responsibilities

The postholder will manage the co-ordination and monitoring of complex packages of care and NHS funded placements. It will be necessary to work closely with patients and their relatives ensuring that they understand the process, the eligibility criteria to be applied, and to provide empathy to patients.

The postholder will have a flexible approach to care and will work across inter-agency boundaries, maintaining good communication and liaison skills with all professionals and members of the public.

The postholder will undertake care reviews for people whose care is fully or partially funded by the NHS ensuring patient focused support and facilitating the most appropriate and cost-effective pathway for individual care.

The postholder will lead the management of packages of care for people in a variety of care and support settings.

The job description and person specification are an outline of the tasks, responsibilities and outcomes required of the role. 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 ongoing basis in accordance with the changing needs of the Department and the Organisation.

Operational Responsibility

To manage a defined caseload undertaking responsibilities as delegated by the Team Leader/Manager - this will include the routine management of complex cases and the planning, organising and commissioning of specialised care packages ensuring the maintenance of accurate records.

To participate in the assessment, monitoring, review and complaints procedures of individuals with varying levels of complex needs whose care is managed in their own homes or in care settings.

To assist or lead (depending on who is the responsible commissioner) in the co-ordination of complex care packages involving members of the multi-disciplinary / multi-professional team as required.

To assist in the collaboration and the co-ordination of the review and assessment process and to undertake reviews and assessments, including formal eligibility assessments as indicated.

To undertake needs portrayal and retrospective assessments for PUPOC and appeals.

To practice at all times in a manner that is within the NMC Code of Conduct and Guidelines or equivalent for specialist health profession.

To practice at all times within a clinical governance framework that promotes quality.

To co-ordinate and commission complex care packages involving members of the multi-disciplinary /

multi-professional team

Financial and Physical Resources Responsibility

To support and inform teams on the targeting of resources, monitoring, implementing, evaluating and delivery of plans by providing sophisticated, high quality information and analysis.

To continually strive for delivering project/function/patient outcomes, value for money and greater efficiency.

To contribute to the financial delivery of the service ensuring it is cost effective and delivered on time.

To commission care to meet individual patient need and ensure best value, least restrictive care is achieved.

To work in collaboration with all providers of care to negotiate packages ensuring optimal value for money and advise on needs for market development purposes

Human Resources Responsibility

To provide specialist training, advice and support on own role/responsibilities across NHS Shropshire, Telford and Wrekin and the wider system.

To participate in the recruitment process of support staff.

To be accountable for own professional development and to participate in performance review.

To attend relevant training and staff meetings as required including participation in nursing and clinical development across NHS Shropshire, Telford and Wrekin.

To commit to undertake clinical supervision.

Information Management Responsibility

To contribute to the review and development of existing information management systems and contribute to the development of an integrated approach.

To maintain accurate and comprehensive clinical records.

To participate in and undertake audits and support the implementation of recommended actions.

To update, maintain, organise, gather and analyse information to predict/meet future organisational and team needs by identifying best professional practice.

To carry out timely and accurate information analysis and reporting on agreed areas of portfolio

To actively support and contribute to the development of key performance indicators for the successful assessment of performance.

Planning and Organisation Responsibility

To plan own workload and diary to ensure local, national and statutory targets and deadlines are met.

To undertake complex clinical assessment and care planning to ensure patient need is met and that where appropriate, step-down/discharge is planned and co-ordinated to ensure patient need is met in the least restrictive way.

To work with members of the team and key stakeholders to investigate the causes of any variance from plan/delivery targets and contribute to the implementation of solutions.

Policy and Service Development Responsibility

To contribute to the strategic planning recommending adjustments, as necessary.

To support implementation of strategic modernisation/service improvement, public health, workforce or commissioning strategies and any associated action plans, in accordance with the agreed priorities of the team

To contribute to the development of performance and governance strategies and the development and implementation of improvement programmes

To deliver against objectives, achieving quality outcomes, prioritising own workload and working to tight deadlines.

To propose changes to own function, informing policy and making recommendations for other projects delivery.

Research and Development Responsibility

To be accountable for own professional development and to participate in performance review.

Person Specification

Essential

Essential

Significant experience of working in a relevant clinical field. 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 Ability to analyse and interpret information, pre-empt and evaluate issues, and recommend and appropriate course of action to address the issues Takes decisions on difficult and contentious issues where they may be a number of courses of action. Ability to work on own initiative and organise own workload without supervision working to tight and often changing timescale Demonstrate a strong desire to improve performance and make a difference by focusing on goals Experience of assessment and commissioning (writing care plans etc)

Desirable

A good understanding of the health and social care environment and roles and responsibilities within this Commissioning experience MCA/BI/DOLS/COP

Experience & Knowledge

Essential

Knowledge and understanding of case managing patients. Understanding of triaging

Qualifications

Essential

Registered with the NMC/HCPC