NursingNetUK

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Complex Case Manager
• To provide professional support, expertise, and input, where required to support the Appeals Procedure 
• To ensure that you and all clinical staff within the CHC team are aware of and adhere to all the ICB policies and procedures. 
• Ensure that you receive the appropriate supervision and annual appraisal enabling your professional development to be maintained
• To participate in audits undertaken by the Head of Joint Care Home Contracting & Procurement and Clinical Operational Leads

Clinical:
• To assess, case manage, monitor, and formally review the health needs of those patients funded by CWICB within Coventry, Rugby, and Warwickshire North places as well as those cases who are placed out of county placements receiving care under CHC.
• To lead MDTs through the CHC assessment and decision-making process, including where  appropriate referring completed assessments to the NHS CHC verification Panel.
• To complete initial determinations and reviews in line with the Funded Nursing Care (FNC) as per the legislation. 
• To act as a resource for health advice and expertise to Health and Social Care staff. 
• To provide specialist training, support, and education to other Health Professionals. 
• To case manage your own clinical caseload (end to end) including, but not limited to, resolving issues with funding, placements, invoices, and complaints. 
• To attend / chair funding panel as required.
• To attend / chair Best Interest meetings and Clinical Treatment Reviews as required. 
• To provide professional support, expertise, and input to Clinical Nurse Assessors. 
• Manage referrals that are being fast tracked through the CHC process for those patients with a rapidly deteriorating condition. 
• To be a member of and take responsibility, with colleagues, for the effective management of the CHC Duty Rota. The CHC Duty role will manage referrals that are being fast tracked through the CHC process for those patients that have rapidly deteriorating conditions, manage the daily enquiries to the CHC Service and any case management issues that arise unexpectedly. 

Complex Case Manager
• To screen referrals and healthcare needs checklists submitted to the CHC service to ensure that they are appropriate and meet the criteria for a full continuing healthcare assessment.
• Oversee and ensure that CHC reviews are carried out as per the National guidance and take responsibility for managing and reviewing complex cases either individually or with the CHC Nurse Assessors. 
• To prepare and manage appeal cases for current appeals and restitution cases for Independent Review Panel relating to the application of any funding request including NHS Continuing Healthcare criteria and assessment processes. 
• Demonstrate evidence-based practice. 
• To participate, inform and support continued service developments. 
Clinical Case Management:
• To work with the acute sector, care managers and contracts managers to facilitate the appropriate Discharge to Assess and/ or long-term placements of patients with health funded needs including NHS Continuing Healthcare to include identification of equipment needs, support services and resources as requested. 
• To provide case management for individuals in receipt of 100% NHS funding to include residential, domiciliary and respite care packages where appropriate, offer advocacy, support to the voluntary sector, and provide advice and information to both the individual and others. 
• To ensure all appropriate correspondence to families and correspondence and queries from families are dealt with efficiently. 
• To be a constant point of contact and support to those involved and lead in the case management of individual cases 
• To deal and manage complaints and queries to their conclusion relating to your case load. 
• To provide accurate assessment (s) of need when required to support identification of appropriate services. This includes avoiding hospital admissions, increase / decrease in care and short term 1-2-1.
Leadership:
• Enable others to understand their contribution to services provided and see development as an opportunity for personal growth and take an active part in the process. 
• Project a positive image of the CHC Team both within and outside of the service. 
• Recognise and communicate the achievements of the Team and individuals within it. 
• Overcome barriers to effective team working. 
• Mentor and support staff when required to address issues and meet their potential and professional development goals.
Partnership working:
• To work with colleagues (Health and Social Care) and other key links to ensure that the eligibility criteria for Health funding are appropriately understood and applied and that training and advice is available. 
• Establish and maintain effective communication and liaison with patients’ other agencies, relatives, and carers. 
• Be knowledgeable and familiar with relevant legislation and professional codes that influence the delivery of care to patients in nursing home care. 
• To participate, inform and support continued service developments.
Finance and activity:
• To work with the Head of Joint Care Home Contracting & Procurement and Clinical Operational Leads, contracting and Placement Team colleagues to ensure best value is achieved for all individual packages of care. 
• Assist the Head of Joint Care Home Contracting & Procurement and Clinical Operational Leads in making appropriate bids for resources. 
• To be responsible for ensuring all costs and changes to packages are recorded accurately on the patient management system.
General 
Other Duties
This job description is not a definitive or exhaustive list of responsibilities but identifies the key responsibilities and tasks of the post holder. The specific objectives of the post holder will be subject to review as part of the individual’s performance review/appraisal. There may be a requirement to undertake other duties as may reasonably be required to support the ICB in accordance with your grade/level in the organisation