Care Coordinator

3 weeks ago

Harrogate, United Kingdom Yorkshire Health Network Full time

Job summary

The Pro-Active Care Team (PACT) works across four Primary Care Networks (PCNs) who all work closely together covering 17 practices in the Harrogate and Rural area. The Pro-Active Care Team focus on the preventative and pro active element of care that currently due to pressures is managed after a crisis has arisen. The team will focus on identifying those patients on lists for all of the practices and as part of a team visit the patient, make assessments, signpost to the appropriate support service, if needed. The team also undertake Common Geriatric Assessments and Advanced Care planning linking with practice and wider community MDT.

Main duties of the job

The Care Coordinator role is integral to the success of the team as they will be using the IT systems to develop and run reports to identify patients, liaising with patients, carers, and families, booking appointments, managing diaries, minuting team meetings, coordinating activity with other agencies, maintaining up to date records, running KPI reports and supporting the lead Occupational Therapist.

About us

Yorkshire Health Network is a federation of all 17 GP practices within the Harrogate and Rural area of the Humber and North Yorkshire ICB (Integrated Care Board).

Our Purpose is derived from three of the key aims and is

Enable services for Primary Care locally, promoting shared working and collaboration. Support our Primary Care Networks development and function. Work strategically with partners to support sustainability of primary care for local people. Job description

Job responsibilities

Utilise population health intelligence to proactively identify patients within the parameters of the PACT pilot to access assessments appropriate to their needs. Liaise with practices on the identification, coding and amendments needed when patients are identified. Take and pass on referrals from practices to the lead Occupational Therapist. Ensure information is updated within SystmOne and other software packages for the support of the patients including care plans, end of life care, geriatric assessments etc. Be the point of contact either by phone or email as required with patients, carers, families to make appointments and follow up links for PACT colleagues. Liaise with other care providers, carers, families, other multi-agencies, for example but not limited to social services, secondary care, GP practices, social prescribing link workers, health and well being coaches, to refer patients as agreed with the patient and the PACT assessor. Help people to manage their needs through answering queries, making and managing appointments, and ensuring that people have good quality written or verbal information to help them make choices about their care. Under the direction of the lead Occupational Therapist, signpost and assist people to access self-management education courses, peer support or interventions that support them to take more control of their health and wellbeing. 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. Coordinate and provide administrative support for the coordination and delivery of MDTs within PACT linking with partners as required. Person Specification

Experience

Essential

Experience of working in healthcare. Experience of working with Word and Excel. Experience in a patient or customer service facing role. Experience in minute taking and meeting coordination including diary management.

Desirable

Experience of working with patient information systems PINNACLE, SYSTMONE, ACCURX and similar. Experience of Primary Care.

Other

Essential

Driving licence and access to a vehicle.

Qualifications

Essential

Educated to GCSE level or equivalent including Mathematics and English (C or above). Willing to undertake specialist training provided by the Personalised Care Institute.

Desirable

NVQ level 3 or A levels in relevant disciplines.

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