High Cost Care and Quality Manager

The post holder will be responsible for managing and reviewing the high-cost care packages that are awarded through the Continuing Healthcare framework and will include those in specialist placements or receiving 1:1 care. The individual will work with providers to negotiate cost of care and to ensure that it meets the needs of the client in full, in the least restrictive and most cost-effective way. Working with other members of the CHC service, they will support in the assessment and consideration of eligibility of CHC, especially where there is a substantial package of care in place.

The role involves hybrid working, and the ICB expects staff to attend one of the SWL ICB offices at least twice a week. Offices are based in Croydon, Sutton, Wimbledon and Teddington.

Main duties of the job

The post holder will be responsible for having oversight of all high-cost packages of care that are provided by the Continuing Healthcare team; both in formal care settings (e.g. Nursing Home) and in the community. They will undertake regular reviews of the clients to ensure the care provided is as least restrictive as possible and meets the needs of the client in full.

The post holder will ensure that where care arrangements can be changed and amended in order to act in a least restrictive and cost-effective way, they negotiate with the client, their representatives and the provider to make these changes. Any changes must be reviewed regularly to ensure the needs of the client are being met.

About us

NHS South West London Integrated Care Board works with partners from across the South West London Integrated Care System (ICS) to develop plans to meet the health needs of the population and secure the provision of health services and is directly accountable for NHS spend and performance in South West London.

NHS South West London Integrated Care Board as part of South West London Integrated Care System, is a partnership of organisations that come together to plan and deliver joined up health and care services to improve the lives of people in our six boroughs: Croydon, Merton, Kingston, Richmond, Sutton and Wandsworth.

Job responsibilities

The post holder will ensure that all care plans to reduce packages of care, including the use of 1:1, is clearly documented and reviewed at agreed intervals. Where advice and opinion is required from other specialists, the post holder will ensure that referrals are made in a timely manner and before any decisions are made to reduce or change care.

The post holder will work with all stakeholders including clients and, where relevant, their families, to ensure that funding decisions are taken in a transparent and consistent manner. Collaborative working with representatives from the local authority is essential to ensure good partnership working and transparency in decision making. The post holder must at all times act in the best interest of the client.

The post holder will ensure they keep accurate records and are able to demonstrate that funding recommendations are evidence based and made according to the criteria described within national CHC frameworks. They will endorse the SWL ICBs NHS Continuing Healthcare and Funded Nursing Care Choice and Equity Policy.

Person Specification Education / Qualifications

• Registered Nurse (adult)
• Member of relevant professional body
• Educated to Masters level or equivalent level of experience of working at a senior level in specialist area.

Knowledge and Experience

• Excellent knowledge of CHC national and local policy
• Excellent knowledge of all aspects of CHC including Clinical, Brokerage, Contracting, Finance, Business Intelligence and Quality
• Experience of undertaking audits and reviews of work processes and reporting on the findings.

Skills and Abilities

• Must be able to provide and receive highly complex, sensitive or contentious information.
• Ability to negotiate with senior stakeholders on difficult and controversial issues
• Ability to analyse complex facts and situations and develop a range of options

Other

• Used to working in a busy environment, managing a caseload, Adaptability, flexibility and ability to cope with uncertainty and change
• Demonstrates commitment to NHS and organisational values and behaviours
• Demonstrate commitment and role
• Model behaviours and actions that support
• Equality, diversity, belonging and inclusion

Disclosure and Barring Service Check

This post is subject to the Rehabilitation of Offenders Act (Exceptions Order) 1975 and as such it will be necessary for a submission for Disclosure to be made to the Disclosure and Barring Service (formerly known as CRB) to check for any previous criminal convictions.

£59,490 to £66,239 a year per annum inclusive of Outer HCAS